Aneurysmal aorto-left ventricular tunnel causing right ventricular outflow tract obstruction, associated with bicuspid aortic valve

Togănel, Rodica; Benedek, Theodora; Şuteu, Carmen Corina; Benedek, Imre

doi:10.1007/s00380-013-0445-8

Cited by 5 publications

(15 citation statements)

References 14 publications

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“…7,9,32 –34 Stenoses of both aortic and pulmonary valves have also been reported. 2,34,35 Coexisting anomalies of the coronary arteries, however, are the most frequent associated lesions. These are reported in 49 (24.8%) of 197 patients with a tunnel terminating in the left ventricle, and in 11 (47.8%) of 23 with a tunnel to the right ventricle.…”

Section: Resultsmentioning

confidence: 99%

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A Review of the Surgical Management of Aorto-ventricular Tunnels

Chowdhury

Anderson

George

et al. 2021

World J Pediatr Congenit Heart Surg

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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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Section: Resultsmentioning

confidence: 99%

“…9,24,64 Most patients with left ventricular tunnels were symptomatic early during postnatal life and underwent correction before the age of six months. 1 –31,35,37 –39,53 …”

Section: Resultsmentioning

confidence: 99%

A Review of the Surgical Management of Aorto-ventricular Tunnels

Chowdhury

Anderson

George

et al. 2021

World J Pediatr Congenit Heart Surg

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“…A bal coronariás tasakból a bal kamrába vezető tunnel az aorta mögött található, a jobb coronariás tasakból a bal kamrába haladó az aorta jobb oldalán fut a jobb kamra kifolyási pályáján keresztül a bal kamra irá-nyába. Ennek a típusnak négy formáját különítik el: 1. a tunnel végig egyforma nagyságú, 2. a tunnel aorta-kam-ra közti szakasza aneurysmaszerűen tág, 3. a tunnel kamrán belüli szakasza aneurysmaszerűen tág (ritkán a jobb kamra kifolyási pályájának szűkületét okozza [3]), 4. a tunnel mindkét szakaszán tágulat van [4]. A tunnel a jobb coronariás tasakból a jobb coronaria eredésétől medialisan, ritkán azzal közös szájadékkal ered.…”

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Aorta–bal kamra tunnel sikeres sebészi kezelése modern noninvazív képalkotó diagnosztika alapján

et al. 2015

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Az aorta-bal kamra tunnel egy ritka veleszületett szívfejlődési rendellenesség, az aortabillentyűt megkerülő kóros kapcsolat az aorta és a bal kamra között. A szerzők egy 14 éves fi ú esetét ismertetik, akinél a jobb Valsalva-tasakban, az eredésénél pericardiumfolttal zárták a tunnelt. A kétdimenziós echokardiográfi ás anatómiai diagnózist háromdi-menzios vizsgálattal egészítették ki és mágneses rezonanciavizsgálattal erősítették meg. Esetük az első az irodalomban, amelynél a fenti komplex diagnosztikát alkalmazták a pre-és posztoperatív kezelés során. Az újonnan alkalmazott transthoracalis háromdimenziós módszerrel optimalizálható az aorta-bal kamra tunnel anatómiai és hemodinamikai diagnosztikája és posztoperatív utánkövetése. Orv. Hetil., 2015, 156(28), 1140-1143.Kulcsszavak: aorta-bal kamra tunnel, 3D echokardiográfi a Successful surgical management of aortico-left ventricular tunnel using modern noninvasive diagnostic imaging methodsAortico-left ventricular tunnel is a rare congenital cardiac defect, which bypasses the aortic valve via the paravalvar connection from the aorta to the left ventricle. The authors report the history of a 14-year-old boy with aortico-left ventricular tunnel in whom the aortic orifi ce arose from the right aortic sinus and was closed by a pericardial patch. The diagnosis was confi rmed by combined two-dimensional and real time three-dimensional echocardiogram and magnetic resonance imaging. This is the fi rst case, in which these complex diagnostic imaging methods have been used in the pre-and postoperative management of this defect. Optimally the new transthoratic three-dimensional echocardiography would be needed to defi ne the anatomy and functional consequences of the aortico-left ventricular tunnel and in the postoperative follow-up. Keywords: aortico-left ventricular tunnel, real time three-dimensional echocardiogramHartyánszky, I., Katona, M., Kádár, K., Apor, A., Varga, S., Simon, J., Tóth, A., Karácsony, T., Bogáts, G. [Successful surgical management of aortico-left ventricular tunnel using modern noninvasive diagnostic imaging methods]. Orv. Hetil., 2015, 156(28), 1140-1143. ESETISMERTETÉS RövidítésekAo = aorta; BKD = balkamra-diasztolé; BKF = balkamra-fal; Bp = bal pitvar; CT = komputertomográfi a; 3D = háromdi-menziós; 3DE = háromdimenziós echokardiográfi a; IVS = interventricularis septum; lin. EF = lineáris ejekciós frakció; MR = mágneses rezonancia; TEE = transoesophagealis echokardiográfi a

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“…Combined with different techniques including color-doppler, two-dimensional (2D) or real-time three-dimensional (3D) can help physicians diagnosing and evaluating the severity of ALVT [13]. When transthoracic echocardiography window is poor, transesophageal echocardiography (TEE) could be considered [10]. TEE is demonstrated preoperatively and intraoperatively to detect the morphology of ALVT and function of valves within a single transducer in both 2D and real-time 3D techniques.…”

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confidence: 99%

“…Retrograde diastolic blood turbulence passing through the tunnel contribute to congestive heart failure eventually [9]. The right ventricular outflow tract obstruction is owing to the right ventricular infundibulum which is close to the sinus of Valsalva suppressed by the end of aneurysmal tunnel [10]. Heart failure and aortic regurgitation often present in the first year of life, however, there are a variation of clinical presentations in different age groups [11,12].…”

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confidence: 99%