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Sui R, Zhong J, Zi J, Wang A. Surgical repair of an aortico-left ventricular tunnel with Takayasu's arteritis. J Cardiothorac Surg 2022; 17:12. [PMID: 35090518 PMCID: PMC8796543 DOI: 10.1186/s13019-021-01746-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 12/26/2021] [Indexed: 11/10/2022] Open
Abstract
Aortico-left ventricular tunnel is a very rare congenital cardiac anomaly, always arises from the right coronary sinus and enters the left ventricle. However, aortico-left ventricular tunnel associated with Takayasu's arteritis has not been described so far in the literature. Here, we present an unusual case of aortico-left ventricular tunnel associated with Takayasu's arteritis in a 44-year-old man.
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Chowdhury UK, Anderson RH, George N, Singh S, Sankhyan LK, Pradeep D, Chauhan A, Sengupta S, Vaswani P. A Review of the Surgical Management of Aorto-ventricular Tunnels. World J Pediatr Congenit Heart Surg 2021; 12:103-115. [PMID: 33407031 DOI: 10.1177/2150135120954809] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present a synthesis of 95 published investigations of the exceedingly rare tunnels that can exist between the aortic root and the left or right ventricles. From the 220 suitable cases included in these investigations, we reviewed the clinical presentations, modalities used for diagnosis, surgical approaches, and outcomes. Diagnostic information was provided by clinical presentation, radiographic findings, saline contrast echocardiography, computed tomographic angiocardiography, magnetic resonance imaging, cardiac catheterization, and angiocardiography. These techniques elucidated the coronary arterial origins and associated defects and defined the disease before surgery. Patients occasionally present with an asymptomatic cardiac murmur and cardiomegaly, but most suffer cardiac failure in the first year of life when the tunnel enters the left ventricle. Antenatal diagnosis by fetal echocardiography is reliable after 18 weeks of gestation. Associated defects, involving the proximal coronary arteries or the aortic or pulmonary valves, are present in nearly half the cases. Prompt diagnosis and surgical repair are important for a favorable outcome. Overall, operative mortality has been cited to be between 3% and 8.3%. Associated congenital coronary arterial anomalies, residual severe aortic stenosis, poor left ventricular function, and rupture of an infected suture line have been the reported causes of death. Despite early surgical intervention, an incidence of 16% to 60% postoperative residual aortic regurgitation of varying severity has been reported. The requirement of further repair or replacement of the aortic valve ranges from 0% to 50%. We submit that an increased appreciation of these details relative to the tunnels will contribute to improved surgical management.
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Affiliation(s)
- Ujjwal Kumar Chowdhury
- Cardiothoracic Sciences Centre, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Robert H Anderson
- Institute of Biomedical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Niwin George
- Cardiothoracic Sciences Centre, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Sukhjeet Singh
- Cardiothoracic Sciences Centre, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Lakshmi Kumari Sankhyan
- Cardiothoracic Sciences Centre, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Doniparthi Pradeep
- Cardiothoracic Sciences Centre, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Abhinavsingh Chauhan
- Cardiothoracic Sciences Centre, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Sanjoy Sengupta
- Cardiothoracic Sciences Centre, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Prateek Vaswani
- Cardiothoracic Sciences Centre, 28730All India Institute of Medical Sciences, New Delhi, India
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3
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Protopapas EM, Anderson RH, Backer CL, Fragata J, Hakim N, Vida VL, Sarris GE, Barron DJ, Berggren H, Hazekamp MG, Ilyin V, Kornoukhov OJ, Kostolny M, Lazarov S, Lo Rito M, Monge MC, Mykychak Y, Nosal M, Prêtre R, Polimenakos AC, Sojak V, Stellin G, Veshti A, Yemets I. Surgical Management of Aorto-Ventricular Tunnel. A Multicenter Study. Semin Thorac Cardiovasc Surg 2020; 32:271-279. [DOI: 10.1053/j.semtcvs.2020.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/31/2020] [Indexed: 11/11/2022]
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4
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Bakas AM, Vardas PN, Farrell AG, Rodefeld MD. Congenital aortic paravalvular tunnel masquerading as a recurrent ventricular septal defect. J Card Surg 2018; 33:289-291. [PMID: 29638016 DOI: 10.1111/jocs.13573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 4-year-old female underwent surgical repair of an unusual variation of an aorto-left ventricular tunnel (ALVT). Serial echocardiograms had demonstrated previous spontaneous closure of a perimembranous ventricular septal defect (VSD). The patient presented with concern for residual VSD which was later demonstrated to be an eccentric jet through an ALVT. This case emphasizes early and accurate diagnosis for ALVTs and how they can be misdiagnosed as VSDs.
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Affiliation(s)
- Anna M Bakas
- Divisions of Cardiothoracic Surgery, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, Indiana
| | - Panos N Vardas
- Divisions of Cardiothoracic Surgery, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, Indiana
| | - Anne G Farrell
- Divisions of Cardiology, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mark D Rodefeld
- Divisions of Cardiothoracic Surgery, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, Indiana
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5
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Abstract
Aorto-ventricular tunnel is an extremely rare congenital heart defect, consisting of failure of attachment of an aortic leaflet along the semilunar hinge. In all published reports the leaflet involved was either the right coronary leaflet, most frequently, or the left coronary leaflet, in most of the cases opening toward the left ventricle, with only one-eighth of the reported cases communicating with the right ventricle. Treatment of the aorto-ventricular tunnel has been anecdotally reported by interventional closure with a device and more frequently with surgical approach, either as an isolated malformation or as associated lesions. To the best of our knowledge, the presence of an aorto-ventricular tunnel of the non-adjacent aortic leaflet in transposition of the great arteries has never been reported. We have observed an aorto-ventricular tunnel involving the non-adjacent leaflet of the aortic root, which after arterial switch became the pulmonary root. The patient presented 18 years after the arterial switch with progressive dilatation of the right ventricle due to severe degree of pulmonary valve regurgitation, confirmed by echocardiography and cardiac MRI. Indication for surgery was given with the plan for a pulmonary valve implantation. Because of the intra-operative finding of disconnection of the anterior leaflet of the pulmonary valve (former aortic valve) along the semilunar hinge, the surgical plan was modified and the anterior leaflet was attached to the valve annulus, with subsequent plasty in correspondence with the right and left commissurae to reduce the size of the dilated annulus to normal diameter. The post-operative course was uneventful, with extubation after few hours and discharge 4 days after surgery, with echocardiography showing trivial degree of pulmonary valve regurgitation. The patient remains in good conditions 6 months after surgery.
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Affiliation(s)
- Antonio F Corno
- Cardiovascular Research Center, University of Leicester, Leicester, United Kingdom.,East Midlands Congenital Heart Center, University Hospitals of Leicester, Glenfield Hospital, Leicester, United Kingdom
| | - Saravanan Durairaj
- East Midlands Congenital Heart Center, University Hospitals of Leicester, Glenfield Hospital, Leicester, United Kingdom
| | - Robert H Anderson
- Institute of Genetic Medicine, International Centre for Life, Newcastle University, Newcastle upon Tyne, United Kingdom
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6
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Transcatheter closure of a residual aorto-left ventricular tunnel: report of a case with a 6-year follow-up. Cardiol Young 2017; 27:1618-1621. [PMID: 28414001 DOI: 10.1017/s1047951117000701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aorto-left ventricular tunnel is an exceedingly rare congenital cardiac defect. Early surgical closure is the treatment of choice. Residual or recurrent tunnel and aortic valve insufficiency are well-recognised complications after surgical repair. In this article, we report on successful transcatheter closure of a residual aorto-left ventricular tunnel using an Amplatzer duct occluder in a 7-year-old boy. The outcome after 6 years of follow-up is encouraging.
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7
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Brink J, d'Udekem Y. Sinus of Valsalva aneurysms, tunnels, fistulas, and blue moons. J Thorac Cardiovasc Surg 2017; 155:e55. [PMID: 28951081 DOI: 10.1016/j.jtcvs.2017.08.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 08/26/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Johann Brink
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Heart Research Group, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Australia.
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8
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Aorta to Right Atrial Tunnel with Postnatal Transcatheter Treatment. JOURNAL OF FETAL MEDICINE 2016. [DOI: 10.1007/s40556-016-0102-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Nakamura Y, Miyaji K, Yoshii T, Ootomo Y, Kimura S. Aorto–Left Ventricular Tunnel Successfully Repaired Immediately After Birth. Ann Thorac Surg 2016; 101:1988-90. [DOI: 10.1016/j.athoracsur.2015.06.105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 06/11/2015] [Accepted: 06/22/2015] [Indexed: 11/28/2022]
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10
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Raimondi F, Bonnet D. Imaging of congenital anomalies of the coronary arteries. Diagn Interv Imaging 2016; 97:561-9. [PMID: 27132711 DOI: 10.1016/j.diii.2016.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 03/23/2016] [Indexed: 11/28/2022]
Abstract
Congenital abnormalities of the coronary arteries are extremely variable and include anomalies of their origin (atresia, anomalies of origin from the aorta or from the pulmonary artery), the course of the epicardiac coronary branches (intramural, myocardial bridge) and distal connections (coronary-cardiac chamber fistulae). In pediatric practice, the diagnosis relies on ultrasound which should be supplemented by additional cardiac imaging in most cases. Multidetector CT is the most widely used imaging technique to identify abnormal courses and relationships with the greater vessels. In this paper, the important diagnostic and prognostic features in the interpretation of coronary imaging in pediatric practice is discussed.
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Affiliation(s)
- F Raimondi
- Pediatric cardiology-M3C, hôpital Necker-Enfants-Malades, AP-HP, université Paris-Descartes, Sorbonne Paris Cité, 149, rue de Sèvres, 75743 Paris cedex 15, France.
| | - D Bonnet
- Pediatric cardiology-M3C, hôpital Necker-Enfants-Malades, AP-HP, université Paris-Descartes, Sorbonne Paris Cité, 149, rue de Sèvres, 75743 Paris cedex 15, France
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11
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Kathare P, Subramanyam RG, Dash TK, Muthuswamy KS, Raghu K, Koneti NR. Diagnosis and management of aorto-left ventricular tunnel. Ann Pediatr Cardiol 2015; 8:103-7. [PMID: 26085759 PMCID: PMC4453176 DOI: 10.4103/0974-2069.157021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Aorto-left ventricular tunnel (ALVT) is a rare congenital extracardiac channel with progressive left ventricular dilatation needs early correction. Materials and Methods: This is a report of diagnosis and management of aorto-left ventricular tunnel (ALVT) over a period of 11 years from a single institution. Seven patients (age range: 7 days-45 years) presented with heart failure. The diagnosis of ALVT was made by transthoracic echocardiogram in all cases. Results: Treatment was refused by two patients who died during follow-up. Surgical closure of the tunnel was done in four cases, of which one needed Bentall procedure. Two patients had residual leak after the surgery. Transcatheter closure using Amplatzer muscular device was performed in two cases (for postoperative residual leak in one and primary procedure in the other). Significant hemolysis developed in one of them, necessitating the removal of the device and closed surgically. This child underwent aortic valve replacement two years later. All the remaining patients were doing well during the median follow-up of 30 months (range: 1.5-9 years). Conclusion: ALVT is a rare and potentially fatal anomaly that is ideally managed surgically. Catheter closure has a limited role.
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Affiliation(s)
- Pallavi Kathare
- Department of Cardiac Surgery, Gutti, Consultant Pediatric Cardiologist, Care Hospital, Hyderabad, Telangana, India
| | | | - Tapan Kumar Dash
- Consultant Pediatric Cardiac Surgery, Care Hospital, Hyderabad, Telangana, India
| | | | - K Raghu
- Consultant Cardiologist, Care Hospital, Hyderabad, Telangana, India
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12
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Contino M, Mangini A, Lemma MG, Romagnoni C, Zerbi P, Gelpi G, Antona C. A geometric approach to aortic root surgical anatomy. Eur J Cardiothorac Surg 2015; 49:93-100. [DOI: 10.1093/ejcts/ezv059] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/23/2015] [Indexed: 11/13/2022] Open
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13
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Abstract
Aortico-left ventricular tunnel is a rare congenital heart defect. Reports on successful device closure of these defects are scarce. We are reporting the first case of device closure of aortico-left ventricular tunnel using an Amplatzer vascular plug III.
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14
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Furtado AD, Peer SM, Bhat S, Mahimarangaiah J. Aorto-left ventricular tunnel: uncommon site of origin and management. Asian Cardiovasc Thorac Ann 2013; 20:591-4. [PMID: 23087308 DOI: 10.1177/0218492312439399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cases of aorto-ventricular tunnel involving the right ventricle and more commonly, the left ventricle have been described. The site of origin is located above the right coronary cusp and occasionally, the left. We describe an aorto-left ventricular tunnel in a 16-year-old girl, with aneurysmal expansion into the right ventricular outflow tract. Its aortic origin was above the commissure of the right and noncoronary cusps of the aortic valve.
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Affiliation(s)
- Arul Dominic Furtado
- Department of Cardiac Surgery, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.
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15
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Shiraishi S, Takahashi M, Watanabe M, Tsuchida M. Surgical repair of aortico-left ventricular tunnel: report of two cases. Asian Cardiovasc Thorac Ann 2013; 21:67-70. [PMID: 23430424 DOI: 10.1177/0218492312443529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Two girls aged 1 and 15 years with heart murmurs were diagnosed with aortico-left ventricular tunnel. In the 1-year-old, the tunnel had an intracardiac aneurysm within the right ventricular outflow tract; both openings were closed The 15-year-old had no aneurysmal dilatation, but she had mild aortic regurgitation; the aortic opening of the tunnel was closed with a patch. Both girls had uneventful postoperative courses with excellent early results.
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Affiliation(s)
- Shuichi Shiraishi
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata City, Japan.
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16
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Zhang YL, Wang M, Xue XP, Hu B. The Value of Live Three-Dimensional Echocardiography in an Adult Patient with Aortico-Left Ventricular Tunnel. Echocardiography 2012; 29:E10-2. [DOI: 10.1111/j.1540-8175.2011.01512.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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17
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Mueller C, Dave H, Prêtre R. Surgical repair of aorto-ventricular tunnel. Multimed Man Cardiothorac Surg 2012; 2012:mms006. [PMID: 24414710 DOI: 10.1093/mmcts/mms006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This report presents a trans-aortic trans-infundibular double-patch repair of an aorto-left ventricular tunnel in a 17-day old male child. It reviews the literature on aorto-ventricular tunnels and debates strategic and surgical options available to correct these defects. Diagnosis of the tunnel in the case described herein was made prenatally. The child was presented with left ventricular dilatation with early and progressive signs of congestive heart failure. Decision for early surgical correction was made considering the quantum of regurgitant jet, diastolic backflow in the aorta and consequent left ventricular dilatation. After establishing cardiopulmonary bypass and arresting the heart, the aorta was transversely opened above the sinotubular junction and the tunnel identified. Aortic valve morphology and the coronary ostia not involved in the tunnel were carefully investigated. Through a transverse infundibulotomy, the thinned outer wall of the tunnel abutting the posterior wall of the infundibular septum was slit open vertically, thus clearly defining the aortic and the left ventricular orifices. The distal tunnel orifice, now presenting as a subaortic Ventricular septal defect (VSD), was closed using a xenopericardial patch and running polypropylene 7-0 stitches. The aortic end of the tunnel was closed in a similar fashion through the aortotomy, remaining clear of the right coronary artery and respecting the aortic valve geometry. The marsupialized wall of the tunnel as seen through the infundibulotomy was sutured with polypropylene stitches. The aortotomy and right ventriculotomy were closed. The postoperative course was uneventful. A follow-up echocardiography at 2 years showed a perfect outcome with no residual tunnel, no aortic stenosis and trivial aortic regurgitation.
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Affiliation(s)
- Christoph Mueller
- Department of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Zurich, Switzerland
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18
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Mitropoulos FA, Laks H, Kanakis MA, Levi D. Aorto-left ventricular tunnel: an alternative surgical approach. Ann Thorac Surg 2006; 82:1113-5. [PMID: 16928557 DOI: 10.1016/j.athoracsur.2005.12.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2005] [Revised: 12/18/2005] [Accepted: 12/20/2005] [Indexed: 11/28/2022]
Abstract
A 10-day-old infant was diagnosed with aorto-left ventricular tunnel. An alternative surgical approach is described. This technique may minimize the risk of aortic valve injury.
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19
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Wang JK, Lin SM, Tsai SK, Liu CM, Chang YY, Chen JA. Transesophageal Echocardiography for Recurrent Aorto-Left Ventricular Tunnel: Transcatheter Closure with an Amplatzer Duct Occluder. Echocardiography 2006; 23:258-9. [PMID: 16524402 DOI: 10.1111/j.1540-8175.2006.00199.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Jou-Kou Wang
- Department of Pediatric Cardiology, National Yang-Ming University, Taipei, Taiwan
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20
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Kim RW, Spray TL. Surgical correction of aortico-left ventricular tunnel. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2006:177-9. [PMID: 16638564 DOI: 10.1053/j.pcsu.2006.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Aortico-left ventricular tunnel is a rare, paravalvular communication of unclear etiology between the ascending aorta and the left ventricle. The resultant regurgitant diastolic blood flow leads to varying degrees of volume overload and congestive heart failure. Diagnosis is typically made postnatally with echocardiography. Surgical correction is the treatment of choice consisting of either patch closure or primary repair of the aortic orifice. Prognosis is good, although a significant percentage of patients will eventually require valve replacement because of progressive aortic valvular insufficiency.
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Affiliation(s)
- Richard W Kim
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
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21
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Abstract
Aorto-left ventricular tunnels are anomalous communications between the ascending aorta and the left ventricle. Prenatal diagnosis, followed by successful surgical management, is rare. We describe a fetus diagnosed with aorto-left ventricular tunnel at 35 weeks who achieved a favourable outcome after immediate postnatal surgical repair.
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Affiliation(s)
- Jacek Kolcz
- Department of Pediatric Cardiac Surgery, Polish-American Children's Hospital, Collegium Medicum, Jagiellonian University, 30-663 Kraków, Poland
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22
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Martins JD, Sherwood MC, Mayer JE, Keane JF. Aortico–left ventricular tunnel: 35-year experience. J Am Coll Cardiol 2004; 44:446-50. [PMID: 15261946 DOI: 10.1016/j.jacc.2004.04.032] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2003] [Revised: 03/25/2004] [Accepted: 04/06/2004] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The purpose of this study was to review our 35 years of experience with aortico-left ventricular tunnel (ALVT), with emphasis on diagnosis, surgical details, and follow-up. BACKGROUND Aortico-left ventricular tunnel is a rare congenital anomaly. Neonatal surgery has been advocated in all due to long-term concern of valvar aortic regurgitation (AR). METHODS We identified 11 patients from 1963 to August 2002. Clinical, echocardiographic, catheterization, and surgical details were reviewed. RESULTS Eight of 11 patients presented at less than six months old (six with congestive heart failure) and three later with a murmur, all with clinical evidence of AR. Associated lesions, most commonly aortic valve and coronary artery anomalies, were present in 45%. Catheter occlusion was considered but not performed in five. Spontaneous occlusion was documented in one. Ten had surgery (nine in our institution), seven with direct suture and two by patch closure of the aortic end of the AVLT. At follow-up (median, 5 years; 1 month to 35 years), all were asymptomatic; three had residual ALVT (one moderate, two small/trivial), with at most mild AR. CONCLUSIONS Aortico-left ventricular tunnel is a rare cardiac malformation with a good post-operative long-term outcome. Associated lesions occurred in 45%. Catheterization should be reserved for patients with unclear non-invasive findings or transcatheter closure. We recommend surgery for most patients. We report spontaneous closure in one patient, prompting consideration of conservative follow-up in rare small, asymptomatic AVLT.
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23
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McMahon CJ, Vick GW, Ravekes WJ. Images in congenital heart disease. Ruptured aneurysm of the sinus of valsalva. Cardiol Young 2001; 11:94-6. [PMID: 11233406 DOI: 10.1017/s1047951100012506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- C J McMahon
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, USA
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24
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Chessa M, Chaudhari M, De Giovanni JV. Aorto-left ventricular tunnel: transcatheter closure using an amplatzer duct occluder device. Am J Cardiol 2000; 86:253-4. [PMID: 10913500 DOI: 10.1016/s0002-9149(00)00873-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- M Chessa
- The Heart Unit, Birmingham Children's Hospital, Birmingham, United Kingdom
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25
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Grab D, Paulus WE, Terinde R, Lang D. Prenatal diagnosis of an aortico-left ventricular tunnel. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2000; 15:435-438. [PMID: 10976489 DOI: 10.1046/j.1469-0705.2000.00119.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Aortico-left ventricular tunnel is a rare abnormal communication between the ascending aorta and the left ventricle. Early diagnosis and prompt surgical repair prevent congestive heart failure or consecutive valvular insufficiency. However, in utero diagnosis of this heart malformation has been rarely described and none of those children survived. We report on a case of aortico-left ventricular tunnel detected at 32 weeks' gestation with a favourable outcome after surgical repair at three months of age.
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Affiliation(s)
- D Grab
- Department of Gynecology and Obstetrics, University of Ulm, Germany
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