Aortico—left ventricular tunnel

Okoroma, E. O.; Perry, Lowell W.; Scott, Lewis P.; McClenathan, James E.

doi:10.1016/s0022-5223(19)40234-1

Cited by 61 publications

(20 citation statements)

References 9 publications

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“…Most frequently, the right coronary leaflet is involved, followed by the left coronary leaflet. 7,8,17 Levy and associates classified the tunnels involving the right coronary leaflet on the basis of the location of the aortic opening relative to the origin of the right coronary artery. 2 When reviewing this feature, Hovaguimian and associates reported that the aortic opening was above the orifice of the right coronary artery in two-fifths of patients, below the orifice in one-quarter, and at the level of the orifice in one-sixth.…”

Section: Surgical Anatomymentioning

confidence: 99%

“…15 From the case reports and small case series, we were able to grade 106 descriptions on this basis, with 37 having slit-like orifices, 46 with extracardiac aneurysms, 15 with intracardiac aneurysms, and 8 with joint aneurysmal formation. [1][2][3][4][5][6][8][9][10][11][12][13][14][15][16][17][18][20][21][22][23][24][25][26][27][28][29][30][31][33][34][35][37][38][39] In the individuals reported from the joint multicenter registry, the aortic opening in 90% of both aortaleft ventricular and aorta-right ventricular tunnels was described as oval. 95 Several authors have noted that the segment of the sinutubular ridge closest to the orifice may be distorted or displaced, but continues to mark the distal limit of the sinus.…”

Section: Surgical Anatomymentioning

confidence: 99%

“…15 Continuous suture or interrupted sutures were placed in either a single layer or double layers. 2,5,8,9,[14][15][16]23,27,63,85,95 External tunnel obliteration using multiple pledgeted sutures. A few investigators have performed external plication using multiple pledgeted sutures.…”

Section: Surgical Approach and Managementmentioning

confidence: 99%

“…In those patients with anomalous origin of the coronary artery from within the tunnel, it is desirable to close only its ventricular end so as to maintain coronary arterial perfusion. 3,7,8,15,36,37,[46][47][48][49][50][51][52]95 Two-patch closure. Several investigators have closed the persisting blind proximal part of the tunnel following obliteration of its aortic end.…”

Section: Surgical Approach and Managementmentioning

confidence: 99%

“…7 The incidence has been estimated to be around 0.04% to 0.1%. [8][9][10] Our search has permitted us to analyze the findings from 197 individuals having tunnels connecting with the left ventricle and 23 individuals with right ventricular tunnels (Supplemental Tables E1 and E2). The age of presentation and severity of symptoms depend on the size of the tunnel and its point of exit.…”

Section: Introductionmentioning

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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