1
|
Chowdhury UK, Anderson RH, George N, Singh S, Sankhyan LK, Pradeep D, Chauhan A, Sengupta S, Vaswani P. A Review of the Surgical Management of Aorto-ventricular Tunnels. World J Pediatr Congenit Heart Surg 2021; 12:103-115. [PMID: 33407031 DOI: 10.1177/2150135120954809] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
Collapse
Affiliation(s)
- Ujjwal Kumar Chowdhury
- Cardiothoracic Sciences Centre, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Robert H Anderson
- Institute of Biomedical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Niwin George
- Cardiothoracic Sciences Centre, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Sukhjeet Singh
- Cardiothoracic Sciences Centre, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Lakshmi Kumari Sankhyan
- Cardiothoracic Sciences Centre, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Doniparthi Pradeep
- Cardiothoracic Sciences Centre, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Abhinavsingh Chauhan
- Cardiothoracic Sciences Centre, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Sanjoy Sengupta
- Cardiothoracic Sciences Centre, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Prateek Vaswani
- Cardiothoracic Sciences Centre, 28730All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
2
|
Miette A, Nuri HA, Pomé G, Santini F. Aorto-Right Ventricular Tunnel: A Case Series and Literature Review. Semin Thorac Cardiovasc Surg 2020; 32:876-880. [PMID: 32428576 DOI: 10.1053/j.semtcvs.2020.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/02/2020] [Indexed: 11/11/2022]
Abstract
Aorto-right ventricular tunnel (ARVT) is a rare cardiac congenital anomaly where an extracardiac channel connects the ascending aorta above the sinutubular junction to the right ventricle. This defect is caused by an abnormal development of the cushions of the aorto-pulmonary outflow tract. A case series and literature review are described. Two cases of ARVT are described. A literature review was conducted, in which 31 cases were reported. In our 2 cases, both ARVTs connected the ascending aorta above the left aortic sinus to the right ventricle (one to the right ventricular outflow tract and one to the right ventricular apex). Both patients underwent successful surgical correction by patch closure of both tunnel orifices, with uneventful postoperative course. Of the 31 ARVT cases described in our review, only 10 patients (32.3%) had an anatomy similar to the 2 cases described. Coronary artery anomalies can be associated, as reported in our 2 patients and in 16 cases (51.6%) in the review. Surgical correction can be achieved by direct closure or, more often, by patch closure of one or both tunnel orifices, depending mostly on coronary anatomy. Two cases of transcatheter device closure were described in literature, in favorable anatomy cases. Careful attention is required during repair to avoid coronary lesions, due to the high incidence of comorbid coronary anomalies.
Collapse
Affiliation(s)
- Ambra Miette
- Unit of Cardiac Surgery, IRCCS Policlinico San Martino - University of Genoa, Genoa, GE, Italy.
| | - Halkawt Ali Nuri
- Unit of Pediatric Cardiac Surgery, Gaslini Pediatric Hospital, Genoa, GE, Italy
| | - Giuseppe Pomé
- Unit of Pediatric Cardiac Surgery, Gaslini Pediatric Hospital, Genoa, GE, Italy
| | - Francesco Santini
- Unit of Cardiac Surgery, IRCCS Policlinico San Martino - University of Genoa, Genoa, GE, Italy
| |
Collapse
|
3
|
Dwivedi SK, Vijay SK, Chandra S, Ahmad N, Saran RK, Singh SK. Giant aorto-right ventricular fistula with single coronary artery. Circulation 2012; 125:e462-5. [PMID: 22431888 DOI: 10.1161/circulationaha.111.045039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Sudhanshu Kumar Dwivedi
- Department of Cardiology, Chatrapati Shahuji Maharaj Medical University, Chowk, Lucknow, Uttar Pradesh, India
| | | | | | | | | | | |
Collapse
|
4
|
Talwar S, Viswambharan Nair V, Sunder Kothari S, Singh Gulati G, Kumar Choudhary S, Airan B. Aortico-Right Ventricular Tunnel with Anomalous Right Coronary Artery. J Card Surg 2011; 26:521-6. [DOI: 10.1111/j.1540-8191.2011.01308.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
5
|
Daniel M, Mavroudis C, Preminger T, Lorber RO, Jacobs ML. Prenatal Diagnosis and Neonatal Surgical Management of a Giant Proximal Right Coronary Artery to Right Ventricular Fistula. World J Pediatr Congenit Heart Surg 2010; 1:243-8. [DOI: 10.1177/2150135110372778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
We report a case of prenatal diagnosis and early neonatal surgical repair of a large proximal right coronary artery to right ventricular fistula. The surgical findings and technical details of the reparative operation are discussed in the context of the differential diagnosis, which, in addition to coronary-cameral fistula, also includes aortoventricular tunnel and ruptured sinus of Valsalva aneurysm. Timely and appropriate diagnosis and surgical management resulted in preserved patency of the right coronary artery and restoration of normal right ventricular function.
Collapse
Affiliation(s)
- Megan Daniel
- Center for Pediatric and Congenital Heart Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Constantine Mavroudis
- Center for Pediatric and Congenital Heart Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Tamar Preminger
- Center for Pediatric and Congenital Heart Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Richard O. Lorber
- Center for Pediatric and Congenital Heart Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Marshall L. Jacobs
- Center for Pediatric and Congenital Heart Diseases, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
6
|
Freund M, Stoutenbeek P, van der Laan M, ter Heide H, Evens J, Strengers J, Haas F. Aortico-Right Ventricular Tunnel: Prenatal Diagnosis Leading to Neonatal Survival. Fetal Diagn Ther 2007; 22:335-8. [DOI: 10.1159/000103291] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Accepted: 07/14/2006] [Indexed: 11/19/2022]
|
7
|
Manning N, Archer N. Treatment and outcome of serious structural congenital heart disease. SEMINARS IN NEONATOLOGY : SN 2001; 6:37-47. [PMID: 11162284 DOI: 10.1053/siny.2000.0033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Serious structural congenital heart disease usually presents to the neonatal paediatrician, although increasingly these conditions are being diagnosed before birth. It is, therefore, important that those dealing with these fetuses and infants have some knowledge of their natural and modified history. The vast majority of lesions can either be corrected or given symptomatic palliation and this review discusses treatment options and provides up-to-date outcome information to enable fetal and neonatal staff to anticipate and to complement information given to families by paediatric cardiologists.
Collapse
Affiliation(s)
- N Manning
- Paediatric Cardiology, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | | |
Collapse
|
8
|
Abstract
A 2-year-old child with aortico-right ventricular tunnel is reported for its rarity. The right coronary artery originated from the distal end of the tunnel. The frequent occurrence of coronary artery origin abnormality with this anomaly is highlighted.
Collapse
Affiliation(s)
- S Talwar
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi
| | | | | | | |
Collapse
|
9
|
Abstract
A successful operation on an infant with a tunnel through which the aorta communicated with the right ventricle is reported. The diagnosis was suspected preoperatively on the basis of two-dimensional Doppler color echocardiography and confirmed by cardiac catheterization. The aortico-right ventricular tunnel originated independently from the left coronary ostium and above the sinus of Valsalva. Patch closure from inside the tunnel under deep hypothermia was successfully performed. Follow-up is satisfactory 5 years later.
Collapse
Affiliation(s)
- F J Vargas
- Unit of Pediatric Cardiovascular Surgery, Hospital Italiano, Buenos Aires, Argentina
| | | | | | | | | |
Collapse
|
10
|
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.
Collapse
Affiliation(s)
- J A van Son
- Department of Cardiac Surgery, Herzzentrum, University of Leipzig, Germany
| | | | | | | |
Collapse
|