Aortico???Left Ventricular Tunnel, an Unusual Congenital Cardiac Anomaly in Adult: Application of a New Operative Technique

Coskun, Kasim Oguz; Bairaktaris, Andreas; Coskun, Sinan Tolga; Arousy, M El; AminParsa, M; Koertke, Heinrich; Koerfer, Reiner

doi:10.1097/01.mat.0000249018.27065.70

Cited by 3 publications

(11 citation statements)

References 9 publications

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“…Several investigators have documented its occurrence after surgical repair, mostly due to suture dehiscence following direct suture. 27,30,31,91 Transcatheter closure for residual aorto-ventricular tunnels has been used successfully using an Amplatzer occluder. It appears a promising alternative and safe method to decrease surgical risk.…”

Section: Resultsmentioning

confidence: 99%

“…2,5,8,9,14 –16,23,27,63,85 The use of patch material at the aortic end of the tunnel ensures tension-free closure, avoiding distortion of the aortic valvar commissures, leaflets, aortic sinus, and coronary ostia. 9,11,16,21,27,34,41,60,62,63,67,76,86,90,91…”

Section: Commentmentioning

confidence: 99%

“…Patch closure of the ventricular end, nonetheless, has been preferentially used in three-quarters of reported cases, possibly reflecting the relative ease of the relevant surgical maneuver and the frequent association of coronary arterial anomalies in patients with right ventricular tunnels. 40,43 –45,91,95…”

Section: Commentmentioning

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%

Section: Commentmentioning

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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“…During the embryonic period, under normal development, degeneration and atrophy occur between the tail of the arterial arch and the right subclavian artery, and finally the arterial arch sends out three main blood vessels, namely the brachiocephalic trunk, left common carotid artery and left subclavian artery, from right to left[8,9]. When degenerative disruption occurs between the right common carotid artery and right subclavian artery, the aberrant right subclavian artery is formed[10]. The present case had a bilateral common carotid artery with aberrant right subclavian artery, which is a rare developmental deformity.…”

Section: Discussionmentioning

confidence: 99%

Bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome: A case report

Sun¹,

Zhang²,

Zhang³

et al. 2019

WJCC

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BACKGROUNDWe report a rare case of numbness in the right hand, finally diagnosed as bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome and explain the cause of these diseases.CASE SUMMARYThe patient was a 65-year-old woman. She complained of dizziness, numbness and weakness of the right hand for 6 mo. She was diagnosed with bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome by ultrasound, enhanced computed tomography, computed tomography angiography and other examinations. Considering the surgical risks, the patient refused the aberrant right subclavian artery stent implantation and was discharged. We hypothesize that these two kinds of deformity and right subclavian steal syndrome may not occur by accident and result from multiple malformations.CONCLUSIONBilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome is rare. This case reminds interventional radiologists of the possibility of these abnormalities before surgery.

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“…Residual or recurrent ALVT, another long-term follow-up concern, is a wellrecognized complication after surgical repair which might be caused by suture dehiscence [23,24]. Djukic and colleagues reported successful transcatheter closure of a residual aortico-left ventricular tunnel using an Amplatzer duct occluder which is a promising alternative and safe method for residual or recurrent ALVT to decrease surgical risk [9].…”

mentioning

confidence: 99%