Aortico-right atrial tunnel in an adult patient

Abstract

We describe an asymptomatic 27-year-old man who presented a continuous murmur, and was found to have a tunnel between the aorta and the right atrium. Successful surgical treatment was performed. We emphasize the rarity of this condition, and discuss its major features.

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

“…In the reported cases, the tunnels originated mostly from the left sinus of Valsalva,2)3)4)5)6) two from the right sinus of Valsalva2)7) and one from the non-coronary sinus of Valsalva 1). In relation to the ascending aorta, the tunnels arising from the left sinus of Valsalva coursed posteriorly, whereas the tunnels originating from the right sinus of Valsalva travelled anteriorly.…”

“…However, in the literature, there are several case reports describing the percutaneous transcatheter closure of ARAT with coils, vascular plugs and duct occluders. The catheter-closure method using coil embolization or vascular plug device can be advised if the coronary ostia origins independently from any of the coronary sinuses, the opening of the right atrial end is small and if there is no associated cardiac anomaly 2)4)6)8). Although our patient was mildly symptomatic, we offered the surgical closure because of the large tortuous aneursymal dilatations and the origins of coronary ostia from the tunnel.…”

“…In the tunnels from the left sinus, LAD and LCX originated seperately from the left sinus 1)3)4)5)6). In some cases, the left coronary or right coronary artery arose from the proximal part of the ARAT 4)7).…”

“…In all reported patients, the coronary angiography demonstrated that the distribution of both coronary arteries appeared normal except the sinus node artery. In some cases, no sinus node artery could be identified on the selective coronary angiograms 1)3)4)5). However, no sinus node dysfunction was present in those cases, as in our case.…”

Aorta-right atrial tunnel leading to heart failure

“…The surgical technique is usually planned taking into account the ARAT's localization, size, and interaction with coronary ostia. Usually surgery is aimed at removal of the connection between right atria, primary repair of right atrium, closing of the aortic side with patch, and if necessary reconstructing coronary ostia [6,7].…”