Congenital Aorto-Cardiac Connections (CACC) Revisited: Introduction of a Novel Anatomic-therapeutic Classification

Multimodality imaging for comprehensive non‐invasive diagnosis of aorto‐left ventricular tunnel in infancy

“…for separate lumen separate wall passage from the aorta, which are the aorto-atrial tunnels. 12 Therefore, further presurgical confirmatory imaging prior to surgery is mandatory. Invasive cardiac catheterization for angiocardiography was used in older case reports whenever diagnosis remains in doubt or for allocation of coronaries.…”

“…proposed a novel classification for aorto‐cardiac connectors into type 1, which is a hole‐like connector for rupture sinus of Valsalva aneurysm, type 2 as an anatomic passage for coronary cameral fistula, and type 3 for extranatomic passages. Type 3 is subclassified into A for separate lumen shared wall passage with the aorta, which are the aorto‐ventricular tunnels and B for separate lumen separate wall passage from the aorta, which are the aorto‐atrial tunnels 12 …”

Aorto-Left Ventricular Tunnel – Prenatal Diagnosis and Outcome

“…Aorto-left ventricular tunnel (ALVT) is an extracardiac paravalvular channel that connects the ascending aorta above the sinotubular junction with the cavity of the left ventricle [1,2]. ALVT is one of the rarest prenatally diagnosed cardiac defects and is part of an entity called abnormal congenital aorto-cardiac communications, a heterogeneous constellation of anomalies resulting in an abnormal connection between the aorta and other cardiac chambers or structures, namely rupture of congenital sinus of Valsalva aneurysm, aorto-left ventricular and less commonly right ventricular tunnels, coronary cameral fistulas, and aorto-atrial communications [3].…”

“…(3 mm at 18 weeks), antegrade flow over AV, to-and-fro flow in AoA, AA aneurysm, CHF, PE, HF Autopsy: AV dysplasia with stenosis TOP at 20.anterior (2.5 mm at 18 weeks), antegrade flow over AV, to-andfro flow in AoA, AA aneurysm, CHF, PE, pleural effusion Autopsy: AV dysplasia with stenosis, non-compacted LV myocardium TOP at 19.ALVT right anterior (3.7 mm at 21 weeks) antegrade flow over AV, to-and-fro flow in AoA, AA aneurysm, CHF, PE TOP at 21.5 weeks A V S A L V T l e f t a n t e r i o r ( 4 m m a t 3 0 w e e k s ) , antegrade flow over AV, to-and-fro flow in AoA, LOT aneurysm, AA aneurysm Autopsy: hypoplastic RCA, chronic ischemic (6 mm at 36 weeks), antegrade flow over AV, to-and-fro flow in AoA, AA aneurysm, CHF, PE, HF Dysplastic MV, non-compacted LV myocardium, severe CHF, pulmonary edema(6 mm at 30 weeks), no flow over AV, to-and-fro flow in AoA, LOT aneurysm, AA aneurysm Severe AS, non-compacted LV myocardium, (2 mm at 30 weeks), severe PS, antegrade flow over AV, antegrade flow in AoA, LOT aneurysm Origin of RCA in ALVT, normal LCA origin al. Aorto-Left Ventricular Tunnel… Ultraschall in Med 2023; 44: e184-e190 | © 2022.…”