Aorta-Right Atrial Tunnel: Imaging and Surgical Repair in an Adult Patient

Tossios, Paschalis; Sarlis, Georgios; Aidonidis, Georgios; Karatzopoulos, Avgerinos; Grosomanidis, Vasilios; Κούσκουρας, Κωνσταντίνος

doi:10.1053/j.jvca.2013.03.025

Cited by 3 publications

(4 citation statements)

References 19 publications

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“…For deeper origin of coronary artery within the tunnel, it should be reimplanted with a part of tunnel into respective of the sinus of Valsalva. [89101112]…”

Section: Discussionmentioning

confidence: 99%

Aorta-right atrial tunnel presenting with heart failure in an adult

et al. 2018

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Aorta-right atrial tunnel (ARAT) is a rare congenital anomaly characterized by extracardiac tunnel-like vascular connection between aorta and right atrium. Patients are usually asymptomatic, but patient may present with palpitation, dyspnea, and fatigue on exertion. Diagnosis can be made by transthoracic echocardiography during investigations for continuous murmur. Diagnosis can be confirmed by computed tomography, aortography, and coronary angiography. We report a case of a 26-year-old man diagnosed with ARAT arising from right sinotubular junction extending anteriorly and opening into right atrium near the opening of superior vena cava complicated with cardiomegaly and heart failure.

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“…For deeper origin of coronary artery within the tunnel, it should be reimplanted with a part of tunnel into respective of the sinus of Valsalva. [89101112]…”

Section: Discussionmentioning

confidence: 99%

Aorta-right atrial tunnel presenting with heart failure in an adult

et al. 2018

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“…It is cost intensive, but has low peri-procedural risk. 12 Percutaneous intervention with a plug or coil is easiest when the coronary arteries arise separately from the tunnel.…”

Section: Discussionmentioning

confidence: 99%

“…CMR angiography was an additional tool used to demonstrate blood flow and quantify the left-to-right shunt. 12 Therefore the combination of CMR and other modalities has improved the diagnostic precision of aorta-right atrial tunnel and has also assisted in ruling out other associated lesions, such as septal defects. 12 Prior to 2003, most cases of ruptured sinus of Valsalva aneurysms were diagnosed using echocardiography and cardiac catheterisation.…”

Section: Diagnosismentioning

confidence: 99%

“…12 Therefore the combination of CMR and other modalities has improved the diagnostic precision of aorta-right atrial tunnel and has also assisted in ruling out other associated lesions, such as septal defects. 12 Prior to 2003, most cases of ruptured sinus of Valsalva aneurysms were diagnosed using echocardiography and cardiac catheterisation. Turkay et al were the first to diagnose right coronary sinus tunnel to the right atrium using electron-beam tomography.…”

Section: Diagnosismentioning

confidence: 99%

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An unusual case of aorta–right atrial tunnel with windsock aneurysm: imaging, diagnosis and treatment

Khan

Scholtz

Snyders

et al. 2017

CVJA

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The first successfully diagnosed and treated case of aortaright atrial tunnel was reported by Coto et al. in 1980. The most common cause of aorta-right atrial tunnel is a ruptured aneurysm of the sinus of Valsalva. Sinus of Valsalva aneurysms had been reported as early as 1840 by Thurnam; these were diagnosed at autopsy. With the advances in radiology, many cases of aorta-right atrial tunnel have been reported since then, each with its own subtle variations.We report on a unique case of aorta-right atrial tunnel with a windsock aneurysm in the right atrium. A 55-yearold male presented with abdominal pain and the chest X-ray revealed cardiomegaly. On further investigation with echocardiography and computed tomography angiography, there was an incidental aorta-right atrial tunnel with a windsock aneurysm in the right atrium. As early as 1840, aneurysms of the sinus of Valsalva were described by Thurnam; these were diagnosed through autopsies. 1 The first successfully diagnosed and treated case of aorta-right atrial tunnel was reported by Coto et al. in 1980. 2 Initially, diagnosis was limited to echocardiography and cardiac catheterisation, but with the advent of 64-slice computed tomography (CT) angiography, diagnostic accuracy and accessibility has improved. We present here a unique case of aorta-right atrial tunnel with a windsock aneurysm in the right atrium, diagnosed with echocardiography and CT angiography and successfully treated with surgery. Case reportA 55-year-old male patient presented with abdominal pain and was admitted to hospital for the treatment of a kidney stone. Two days after the stone was removed and a stent was placed, he complained again of severe abdominal pain, nausea and vomiting. He was thoroughly examined; the abdominal CT and ultrasound were normal. The cause of abdominal pain was due to a urinary tract infection, which he had contracted after the urinary tract stone was removed. The abdominal symptoms were unrelated to the cardiac findings. The chest radiograph, however, demonstrated cardiomegaly. He was then referred to a cardiologist.The patient had no history of cardiac disease and reported no chest pain or palpitations. He had normal effort tolerance. In retrospect he recalled some ankle swelling during the afternoons and mild peri-orbital swelling during the mornings. His surgical history included a Nissen fundoplication.A transthoracic echocardiogram demonstrated a large left atrium and left ventricle. No left ventricular hypertrophy was reported. Ejection fraction on M-mode was normal. A significant finding was an impression on the enlarged right atrium from a possible adjacent lesion.The transoesophageal echocardiogram (TEE) confirmed normal valvular and left ventricular function. There was an aneurysm of the aortic sinus with a windsock in the right atrium, possibly increasing the pressure and volume in the right atrium (Figs 1-3).A CT angiogram was performed subsequent to the TEE. There was aneurysmal dilatation of the right coronary sinus with a tortuous dilated t...

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