Aorto-left ventricular tunnel with anomalous origin of right coronary artery and bicuspid aortic valve: a case report

Ma, Xiaochun; Li, Jinzhang; Zhang, Qian; Kong, Xiangqian; Yuan, Gui-dao; Wang, Zhengjun

doi:10.1186/s13019-018-0770-1

Cited by 2 publications

(6 citation statements)

References 5 publications

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“…9,24,64 Most patients with left ventricular tunnels were symptomatic early during postnatal life and underwent correction before the age of six months. 1 –31,35,37 –39,53 …”

Section: Resultsmentioning

confidence: 99%

“…In an isolated case, the aortic opening was closed directly using continuous 5-0 polypropylene suture. 38…”

Section: Resultsmentioning

confidence: 99%

“…The overall reported mortality for patients undergoing repair of isolated aorta-left ventricular tunnel prior to 1983 was around 20%. 1 …”

Section: Resultsmentioning

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%

“…9,24,64 Most patients with left ventricular tunnels were symptomatic early during postnatal life and underwent correction before the age of six months. 35,[37][38][39] In contrast, the majority of patients with right ventricular tunnels were asymptomatic in infancy. Surgery for right ventricular tunnels was performed in 9 (43%) infants and in 57% of patients beyond one year of age.…”

Section: Surgical Approach and Managementmentioning

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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“…9,24,64 Most patients with left ventricular tunnels were symptomatic early during postnatal life and underwent correction before the age of six months. 1 –31,35,37 –39,53 …”

Section: Resultsmentioning

confidence: 99%

“…In an isolated case, the aortic opening was closed directly using continuous 5-0 polypropylene suture. 38…”

Section: Resultsmentioning

confidence: 99%

“…The overall reported mortality for patients undergoing repair of isolated aorta-left ventricular tunnel prior to 1983 was around 20%. 1 …”

Section: Resultsmentioning

confidence: 99%

Section: Surgical Anatomymentioning

confidence: 99%

Section: Surgical Approach and Managementmentioning

confidence: 99%

See 3 more Smart Citations

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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Characteristics and long-term outcomes of aortico-left ventricular tunnel

Sun

Lin

et al. 2020

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES Aortico-left ventricular tunnel (ALVT) is an extremely rare, abnormal paravalvular communication between the aorta and the left ventricle. Few studies have identified the characteristics and long-term prognosis associated with ALVT. METHODS The data of 31 patients with ALVT from July 2002 to December 2019 were reviewed. Echocardiography was performed in all patients during the follow-up period. RESULTS The median age of the patients was 11.5 years. Bicuspid aortic valve and dilatation of the ascending aorta were found in 13 patients, respectively. The aortic orifice in 20 patients showed a close relation to the right sinus and the right–left commissure. Of the 31 patients, 26 were operated on. Mechanical valve replacement was performed in 4 patients and aortic valve repair, in 6 patients. Ascending aortoplasty was performed in 5 patients and aortic replacement was done in 2 patients. One patient died of ventricular fibrillation before the operation. Follow-up of the remaining 30 patients ranged from 1 to 210 months (median 64 months). There were 4 deaths during the follow-up period: 1 had mechanical valve replacement and 3 did not undergo surgical repair. In the 26 patients without aortic valve replacement, 6 had severe regurgitation and 2 had moderate regurgitation. In the 28 patients without replacement of the ascending aorta, 11 had continued dilatation of the ascending aorta, including those who had aortoplasty. CONCLUSIONS The aortic orifice of ALVT showed an association with the right sinus and the right–left commissure. For patients who did not have surgery, the long-term survival rate remained terrible. Surgical closure should be done as soon as possible after ALVT is diagnosed. The main long-term complications after surgical repair included aortic regurgitation and ascending aortic dilatation.

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Aorto-left ventricular tunnel with anomalous origin of right coronary artery and bicuspid aortic valve: a case report

Cited by 2 publications

References 5 publications

A Review of the Surgical Management of Aorto-ventricular Tunnels

A Review of the Surgical Management of Aorto-ventricular Tunnels

Characteristics and long-term outcomes of aortico-left ventricular tunnel

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