Aortico-Left Ventricular Tunnel: A Clinical Review and New Surgical Classification

Hovaguimian, Hagop; Çobanoğlu, Adnan; Starr, Albert

doi:10.1016/s0003-4975(10)62413-7

Cited by 94 publications

(122 citation statements)

References 21 publications

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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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Section: Megbeszélésunclassified

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

et al. 2015

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“…Subsequently, Hovaguimian and colleagues [2] proposed a classification based on local anatomic findings of ALVT as follows:…”

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“…The potentially underlying mechanisms to elaborate the pathogenesis were proposed as follows: coronary artery anomalies, fragility of the intercommissural line, abnormalities of the distal part of bulbus cordis, early or intrauterine rupture of Valsalva sinus aneurysm, early aortic dissection similar to connective tissue disease such as Marfan syndrome, or a remnant of the fifth aortic arch [2,20]. Surgical intervention is recommended as soon as possible after diagnosis is made because of high medically-treated mortality, even in asymptomatic patients [3].…”

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Aortico-left ventricular tunnel: updated perspectives

Jhou¹,

Ke²,

Chen³

et al. 2018

Trends Med

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“…Some authorities believe it to be an abnormal coronary artery; others have ascribed it to early aortic dissection, and still others have attributed it to persistent embryonic rests of the fifth aortic arch or to malformation of the distal bulbus cordis. 2 There is no specific genetic defect identified to date. However, cystic medial degeneration has been demonstrated in an aortic aneurysm from a patient with repaired ALVT, making connective tissue disease an important contender for the underlying defect.…”

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confidence: 99%

Aorto-Left Ventricular Tunnel in a Multianeurysmal Heart

et al. 2015

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A 25-year-old male presented to us with multiple episodes of syncope during the past 6 months. Physical examination was remarkable for bradycardia, an increased pulse pressure, and a systolico-diastolic murmur associated with thrill at the aortic area. ECG (Figure 1) showed complete heart block with a wide QRS escape. Twodimensional transthoracic echocardiography with color Doppler (Figures 2 and 3 and Movies I-IV in the onlineonly Data Supplement) showed the presence of a calcified aneurysmal structure arising from the ascending aorta just above the sinutubular junction, a left ventricular outflow tract (LVOT) aneurysm, a submitral left ventricle aneurysm, along with severe aortic regurgitation and infundibular pulmonic stenosis (PS). Multidetector computed tomography with volume rendering (Figures 4 and 5) clearly demonstrated the aortic and the left ventricular site of communication of the aneurysmal aorto-left ventricular tunnel (ALVT) as well as the unusual course of the ALVT burrowing into the proximal interventricular septum. The communication of the ALVT with the LVOT aneurysm was clearly demonstrated on multidetector computed tomography, as were the submitral aneurysm and infundibular PS. The PS was seen to be the result of a combination of infundibular hypertrophy and compression by the aneurysmal ALVT. The patient was implanted with a permanent pacemaker and referred to cardiothoracic surgery for definitive management.ALVT is a rare congenital entity, with ≈130 cases having been described in literature so far.1 It is distinguished from a ruptured sinus of Valsalva aneurysm by having its aortic connection above the sinutubular ridge. Various hypotheses have been put forward regarding its cause. Some authorities believe it to be an abnormal coronary artery; others have ascribed it to early aortic dissection, and still others have attributed it to persistent embryonic rests of the fifth aortic arch or to malformation of the distal bulbus cordis.2 There is no specific genetic defect identified to date. However, cystic medial degeneration has been demonstrated in an aortic aneurysm from a patient with repaired ALVT, making connective tissue disease an important contender for the underlying defect.1 The presence of multiple cardiac aneurysms in this patient adds credence to this hypothesis. However, although the patient did have a marfanoid habitus with a reduced upper to lower segment ratio and a positive wrist and thumb sign (Figure 6), he did not meet the revised Ghent criteria for Marfan syndrome. There was no family history of Marfan syndrome and no ocular involvement. Genetic testing could not be performed because the facility was not available to us. ALVT is commonly associated with other cardiac anomalies, the most frequent being coronary artery anomalies followed by aortic valve abnormalities. However, its association with other cardiac aneurysms has not been reported. On the right side, pulmonary valvular involvement occurs in ≤5% of cases. Significant right ventricular outflow tract (RVOT) obstru...

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Aortico-Left Ventricular Tunnel: A Clinical Review and New Surgical Classification

Cited by 94 publications

References 21 publications

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

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

Aortico-left ventricular tunnel: updated perspectives

Aorto-Left Ventricular Tunnel in a Multianeurysmal Heart

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