Congenital Aorto-Left Atrial Tunnel—An Unusual Communication: A Case Report

Abstract

Congenital aortico-cameral communications are rarely seen. We present an asymptomatic patient in whom there was a congenital vascular communication rising from the aortic root and terminating in the left atrium. She had an atrial septal defect (ASD). The diagnosis was made with echocardiography and confirmed by aortography. She was treated by closing the tunnel and the ASD. The outcome was satisfactory in this extremely rare case of a congenital cardiac lesion. Coincidental diagnosis could be made during careful echocardiographic examination.

Transcatheter Device Closure of a Congenital Aortic-Left Atrial Tunnel

“…This is the first case report, to the authors' knowledge, describing an aortic–left atrial tunnel closed by interventional cardiac catheterization. Contemporary cases of aortic–left atrial tunnel diagnosed initially by transthoracic echocardiogram were confirmed by additional imaging modalities and closed surgically …”

“…Unlike previous cases in the literature, the aortic–left atrial tunnel was an isolated finding. Other reports of aortic–left atrial tunnel have been associated with coronary artery anomalies, bicuspid aortic valve, and secundum atrial septal defects . Indications for closure of the tunnel include left ventricular volume overload as well as the risk of endocarditis, aneurysm formation, and vascular rupture.…”

“…Aortic–left atrial tunnels have lower reported incidence than aortic–right atrial tunnels and may be congenital in nature or acquired following vascular injury. Rare cases of asymptomatic aortic–left atrial tunnels exist in the literature . In 1961, one of the earliest published reports of an aortic–left atrial communication was diagnosed upon necropsy in a 7‐month‐old infant with severe congestive heart failure.…”

“…Management options for an aortic–left atrial tunnel include surgical or transcatheter repair. Aortic‐atrial tunnels have historically been repaired surgically . The avoidance of a sternotomy and postoperative recovery period make transcatheter treatment an attractive option.…”

“…Aortic–left atrial tunnel is a rare vascular anomaly, but a thorough echocardiographic assessment possesses the capability of differentiating it from the more common aorta to atrial communications such as ruptured sinus of Valsalva or coronary‐cameral fistula. All previously published reports of aortic–left atrial tunnel have been surgically repaired . This is the first report, to the authors' knowledge, describing an aortic–left atrial tunnel closed by interventional cardiac catheterization in a pediatric patient.…”