Aorta-Right Atrial Tunnel: An Interesting Type of a Congenital Coronary Artery Anomaly

İyisoy, Atila; Çelik, Turgay; Çelik, Murat; Sağ, Cemal

doi:10.4070/kcj.2014.44.3.193

Cited by 6 publications

(3 citation statements)

References 8 publications

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“…[ 9 ] Aneurysmal enlargement of the sinoatrial nodal artery and communication to the right atrium is yet another embryological explanation. [ 16 ]…”

Section: Discussionmentioning

confidence: 99%

Aortico right atrial tunnel – Clinical presentation, transcatheter management, and follow-up from a large cohort of patients

Sivakumar,

Singhi,

Sankarakuttalam

et al. 2024

Annals of Pediatric Cardiology

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Background: Aortico right atrial tunnel (ARAT) is a rare extracardiac communication between the aorta and the right atrium with two anatomical types. A recent global review identified 59 patients. Methods: Patients with ARAT from two centers were analyzed for their demographics, symptoms, morphology, management, and follow-up thromboprophylaxis. Results: Among 21 patients including 8 males with a median age of 3 years (18 days–72 years) diagnosed as ARAT, 12 (57%) had posterior tunnels and 9 had anterior tunnels. Four patients had multiple exits. Eighteen tunnels were closed after arteriovenous circuit formation. Six patients (29%) weighing <10 kg presented early with heart failure. Transcatheter closure normalized the hemodynamics including in one infant after failed surgery. Two elderly patients (10%) above 60 years presented with angina and atrial fibrillation. The rest were asymptomatic. Occluders were positioned in the narrow proximal aortic end of the tunnel in all except two patients, where the distal atrial end was closed. All procedures were successful without complications. There was one late death after 1 year from subarachnoid hemorrhage. At a median follow-up of 96 months, all survivors were asymptomatic. Thromboprophylaxis with dual antiplatelets for 1–2 years followed earlier was recently changed to aspirin with Coumadin. Complete remodeling occurred when the proximal aortic end was closed, but partial persistence of the track was noted after distal closure. Conclusions: This largest cohort of ARAT showed the safety and efficacy of transcatheter closure even in neonates. The narrow proximal aortic end should be the target for closure rather than the distal atrial end to achieve complete remodeling.

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“…[ 9 ] Aneurysmal enlargement of the sinoatrial nodal artery and communication to the right atrium is yet another embryological explanation. [ 16 ]…”

Section: Discussionmentioning

confidence: 99%

Aortico right atrial tunnel – Clinical presentation, transcatheter management, and follow-up from a large cohort of patients

Sivakumar,

Singhi,

Sankarakuttalam

et al. 2024

Annals of Pediatric Cardiology

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“…Immediate treatment after diagnosis is recommended for symptomatic ARAT (1,9). This treatment could be surgery or transcatheter closure.…”

Section: Discussionmentioning

confidence: 99%

Congenital Descending Aorta-Right Atrial Tunnel: A Case Report

Zhang

Yang

et al. 2020

Front. Pediatr.

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Introduction: Congenital descending aorta-right atrial tunnel is a rare congenital heart defect. Herein, a new case successfully treated by transcatheter closure using a new type of ventricular septal defect occluder from the aortic side was reported. Case Presentation: An 11-month-old Chinese girl presenting with a cardiac murmur was suspected with partial anomalous pulmonary venous connection as assessed by echocardiography. Descending aorta-right atrial tunnel was confirmed by computed tomography angiography and cardiac catheterization. Subsequently, transcatheter closure was performed successfully using a new type of ventricular septal defect occluder from the aortic side. The cardiac murmur disappeared after the intervention, and echocardiography did not reveal any abnormal flow inside the right atrium. At 6 months, the patient had no murmur, and no residual shunt was found using the echocardiogram. Conclusion: Descending aorta-right atrial tunnel is a rare anomaly. Transcatheter closure was successful in our case. Long-term follow-up is needed to assess any progressive growth of the residual tunnel.

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“…4 The aetiopathogenesis of congenital aneurysms is poorly understood. 5 The right coronary sinus and the non-coronary sinus arise embryologically from the fusion of the bulbar septum and truncal ridges. Incomplete fusion can result in aneurysm formation within the septum when subjected to long-standing systemic arterial pressure (left-to-right shunt).…”

Section: Discussionmentioning

confidence: 99%

An unusual case of aorta–right atrial tunnel with windsock aneurysm: imaging, diagnosis and treatment

Khan

Scholtz

Snyders

et al. 2017

CVJA

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The first successfully diagnosed and treated case of aortaright atrial tunnel was reported by Coto et al. in 1980. The most common cause of aorta-right atrial tunnel is a ruptured aneurysm of the sinus of Valsalva. Sinus of Valsalva aneurysms had been reported as early as 1840 by Thurnam; these were diagnosed at autopsy. With the advances in radiology, many cases of aorta-right atrial tunnel have been reported since then, each with its own subtle variations.We report on a unique case of aorta-right atrial tunnel with a windsock aneurysm in the right atrium. A 55-yearold male presented with abdominal pain and the chest X-ray revealed cardiomegaly. On further investigation with echocardiography and computed tomography angiography, there was an incidental aorta-right atrial tunnel with a windsock aneurysm in the right atrium. As early as 1840, aneurysms of the sinus of Valsalva were described by Thurnam; these were diagnosed through autopsies. 1 The first successfully diagnosed and treated case of aorta-right atrial tunnel was reported by Coto et al. in 1980. 2 Initially, diagnosis was limited to echocardiography and cardiac catheterisation, but with the advent of 64-slice computed tomography (CT) angiography, diagnostic accuracy and accessibility has improved. We present here a unique case of aorta-right atrial tunnel with a windsock aneurysm in the right atrium, diagnosed with echocardiography and CT angiography and successfully treated with surgery. Case reportA 55-year-old male patient presented with abdominal pain and was admitted to hospital for the treatment of a kidney stone. Two days after the stone was removed and a stent was placed, he complained again of severe abdominal pain, nausea and vomiting. He was thoroughly examined; the abdominal CT and ultrasound were normal. The cause of abdominal pain was due to a urinary tract infection, which he had contracted after the urinary tract stone was removed. The abdominal symptoms were unrelated to the cardiac findings. The chest radiograph, however, demonstrated cardiomegaly. He was then referred to a cardiologist.The patient had no history of cardiac disease and reported no chest pain or palpitations. He had normal effort tolerance. In retrospect he recalled some ankle swelling during the afternoons and mild peri-orbital swelling during the mornings. His surgical history included a Nissen fundoplication.A transthoracic echocardiogram demonstrated a large left atrium and left ventricle. No left ventricular hypertrophy was reported. Ejection fraction on M-mode was normal. A significant finding was an impression on the enlarged right atrium from a possible adjacent lesion.The transoesophageal echocardiogram (TEE) confirmed normal valvular and left ventricular function. There was an aneurysm of the aortic sinus with a windsock in the right atrium, possibly increasing the pressure and volume in the right atrium (Figs 1-3).A CT angiogram was performed subsequent to the TEE. There was aneurysmal dilatation of the right coronary sinus with a tortuous dilated t...

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Aorta-Right Atrial Tunnel: An Interesting Type of a Congenital Coronary Artery Anomaly

Cited by 6 publications

References 8 publications

Aortico right atrial tunnel – Clinical presentation, transcatheter management, and follow-up from a large cohort of patients

Aortico right atrial tunnel – Clinical presentation, transcatheter management, and follow-up from a large cohort of patients

Congenital Descending Aorta-Right Atrial Tunnel: A Case Report

An unusual case of aorta–right atrial tunnel with windsock aneurysm: imaging, diagnosis and treatment

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