Repair of aortico-right ventricular tunnel

Abstract

Aortico-right ventricular tunnel was successfully corrected in a 15-month-old child. Both the aortic and right ventricular openings were closed with pledgeted sutures. The coronary artery anatomy was normal. At 12-month follow-up the patient is in excellent clinical condition. Before surgical intervention for aortico-right ventricular tunnel is undertaken, every effort should be made to diagnose the coronary artery anatomy, because failure to do so in the case of aberrant origin of a coronary artery may prevent successful surgical correction.

Aortico-Right Ventricular Tunnel with Anomalous Right Coronary Artery

“…Surgery is safe and effective since the anatomy can be confirmed intraoperatively and the coronary artery origin can be identified and protected during closure. If no coronary origin is demonstrated from the tunnel, both the aortic and the right ventricular end can be closed by either direct oversewing 4,7,14 or using a patch, which we have preferred. The origin of any coronary artery from the tunnel precludes the closure of the aortic end.…”

“…This tunnel may connect the ascending aorta above the sinotubular junction to either the left or the right ventricle. Although more than 130 cases of aorto‐left ventricular tunnel have been reported, aorto‐right ventricular tunnel (ARVT) is a rare entity and only 14 cases have been reported 1–14 . This condition presents early in life with an obligatory left to right shunt 15 .…”

Aortico-Right Ventricular Tunnel: Prenatal Diagnosis Leading to Neonatal Survival

“…A tunnel arises via a bulge from the aortic root. An abnormal origin of the coronary arteries is common and there is no dilatation of the coronary arteries as commonly seen in the presence of fistulas [5,6,9] . The main fetal echocardiographic features of an aortico-right ventricular tunnel are an abnormal connection between the ascending aorta and the right ventricle with a bidirectional flow in the color Doppler.…”

“…After showing signs of ischemia our patient underwent urgent heart catheterization and corrective surgery 8 h after birth. Without prenatal diagnosis it is hypothesized -according to the literature [1,3,5] -that a delay in diagnosis would have meant cardiac decompensation and a fatal outcome. Therefore, prenatal diagnosis altered the perinatal management.…”

“…Close attention should be paid to the myocardial perfusion as an aortico-right ventricular tunnel coincides with an abnormal origin of coronary arteries [3,5] . Closure was performed at the distal part of the tunnel because of an abnormal origin of the left circumflex coronary artery and an anterolateral branch arising from the midportion of the tunnel.…”