Clinical implications of prenatal diagnosis of aorto-left ventricular tunnel on postnatal treatment and final outcome

Košutić, Jovan; Prijić, Sergej; Stajevic, Mila; Kalaba, Marija; Ninić, Sanja; Miković, Željko; Vujic, Ana; Popović, Slobodan

doi:10.24953/turkjped.2017.03.019

Cited by 4 publications

(11 citation statements)

References 9 publications

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“…Despite the recent improvement in routine ultrasound screening, prenatal diagnosis is still challenging and rare. Moreover, in the previous series, only a few newborns antenatally detected have survived whatever the performed postnatal cares (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 97%

Prenatal Diagnosis of Aorto-Left Ventricular Tunnel With Dysplastic Bicuspid Aortic Valve: From Fetal Cardiac Failure to Favorable Outcome

et al. 2020

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Aorto-left ventricular tunnel (ALVT) is a rare congenital heart defect. Surgery has to be performed early to avoid life-threatening complications. Prenatal diagnosis of this defect is challenging. We report a case of ALVT diagnosed in a fetus showing premature severe cardiac failure at 24 GA. The new born was operated at day 3 of life with good results. Two years later, he is still doing well recovering a complete normal cardiac function. ALVT should be suggested in front of any fetal cardiac failure. Thanks to early diagnosis, prompt neonatal management can be organized and allows positive outcome.

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Section: Introductionmentioning

confidence: 97%

Prenatal Diagnosis of Aorto-Left Ventricular Tunnel With Dysplastic Bicuspid Aortic Valve: From Fetal Cardiac Failure to Favorable Outcome

et al. 2020

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“…2,5,8,9,14 –16,23,27,63,85 The use of patch material at the aortic end of the tunnel ensures tension-free closure, avoiding distortion of the aortic valvar commissures, leaflets, aortic sinus, and coronary ostia. 9,11,16,21,27,34,41,60,62,63,67,76,86,90,91…”

Section: Commentmentioning

confidence: 99%

“…16,86 The reasons for the regurgitation are multifactorial and include preexisting valvar anomalies, in particular, the extent of the leaflet unsupported by the sinus, tearing at the site of suturing, rupture of an infected suture line, turbulence-related damage to the leaflet, surgical manipulation of the leaflets, distortion and perforation of the leaflet, persisting patency of the ventricular end of the tunnel, and distortion of the supporting aortic sinus with so-called annuloaortic ectasia. 9,15,16,27,30,31,86,90,91,94,95 Thus, the initial repair of aorto-ventricular tunnels must not only close the communication, but reinforce, strengthen, and support the aortic sinus in order to maintain cusp competence and reduce subsequent turbulence-related cuspal distortion.…”

Section: Commentmentioning

confidence: 99%

“…Diagnosis can usually be made by saline contrast echocardiography with either transthoracic or transesophageal imaging (Figures 1 and 2). 9,10,26,[65][66][67][68][90][91][92][93][94][95] It is possible to diagnose the tunnels during fetal life after 18 weeks of gestation. Left ventricular hypertrophy and dilation, with progressive deterioration of its shortening fraction, are consistent features.…”

Section: Diagnosismentioning

confidence: 99%

“…2,5,8,9,[14][15][16]23,27,63,85 The use of patch material at the aortic end of the tunnel ensures tension-free closure, avoiding distortion of the aortic valvar commissures, leaflets, aortic sinus, and coronary ostia. 9,11,16,21,27,34,41,60,62,63,67,76,86,90,91 Although the choice of the surgical approach is dependent on the judgment of the operating surgeon, instances of right ventricular outflow tract obstruction are reported subsequent to closure of only the aortic end of the tunnel. 9,[33][34][35] There has been angiographic documentation of aneurysmal dilation of the proximal end of the blind pouch due to residual high pressure, especially in the setting of left ventricular tunnels.…”

Section: Commentmentioning

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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The aorto‐left ventricular tunnel from a fetal perspective: Original case series and literature review

et al. 2022

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Introduction Aorto‐left ventricular tunnel (ALVT) accounts for <0.1% of congenital heart defects. Evidence on the prognosis from a fetal perspective is limited. With this retrospective international case series, we provide information on the outcome of fetuses with ALVT. Methods All members of the Association for European Pediatric and Congenital Cardiology's (AEPC) fetal working group and fetal medicine units worldwide were invited for participation. We observed antenatal parameters, neonatal outcome and postnatal follow‐up. Additionally, a systematic search of the literature was performed. Results Twenty fetuses with ALVT were identified in 10 participating centers (2001–2019). Fetal echocardiographic characteristics of ALVT included an increased cardiac–thorax ratio (95%), left ventricular end‐diastolic diameter (90%) and a dysplastic aortic valve (90%). Extracardiac malformations were rare (5%). Eight fetuses died at a median gestational age (GA) of 21 + 6 weeks (range, 19–24): all showed signs of hydrops prior to 24 weeks or at autopsy. All others (60%, 12/2) were live–born (median GA 38 + 4, range 37–40), underwent surgery and were alive at last follow up (median 3.2 years, range 0.1–17). The literature reported 22 ALVT fetuses with similar outcome. Conclusions In the absence of fetal hydrops, ALVT carries a good prognosis. Fetuses who survive to 24 weeks without hydrops are likely to have a good outcome.

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Clinical implications of prenatal diagnosis of aorto-left ventricular tunnel on postnatal treatment and final outcome

Cited by 4 publications

References 9 publications

Prenatal Diagnosis of Aorto-Left Ventricular Tunnel With Dysplastic Bicuspid Aortic Valve: From Fetal Cardiac Failure to Favorable Outcome

Prenatal Diagnosis of Aorto-Left Ventricular Tunnel With Dysplastic Bicuspid Aortic Valve: From Fetal Cardiac Failure to Favorable Outcome

A Review of the Surgical Management of Aorto-ventricular Tunnels

The aorto‐left ventricular tunnel from a fetal perspective: Original case series and literature review

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