Diagnosis and Surgical Treatment of Adult Aortico-Right Ventricular Tunnel

Repair of a Ventricular Septal Defect in a Patient with Left Lung Agenesis

“…Although more than 130 cases of aorto-left ventricular tunnel have been reported, aorto-right ventricular tunnel (ARVT) is a rare entity and only 14 cases have been reported. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] This condition presents early in life with an obligatory left to right shunt. 15 We report our experience of successful surgical management of two cases of ARVT with associated coronary artery anomaly.…”

“…In the report by Hruda et al, 10 magnetic resonance angiogram was used for coronary assessment in a five-month-old baby. CT angiogram was used as the confirming investigational modality for the first time for this condition in the report by Lin et al 14 The diagnosis of ARVT is in itself an indication for intervention since untreated, the condition has an unfavorable natural history due to rapid progression of pulmonary vascular disease and death. Transcatheter device closure has been successfully performed for a single patient by Poptani et al 13 However, the patient was five years of age and the investigations clearly ruled out any coronary artery origin from the tunnel making the percutaneous intervention easier.…”

“…Surgery is safe and effective since the anatomy can be confirmed intraoperatively and the coronary artery origin can be identified and protected during closure. If no coronary origin is demonstrated from the tunnel, both the aortic and the right ventricular end can be closed by either direct oversewing 4,7,14 or using a patch, which we have preferred. The origin of any coronary artery from the tunnel precludes the closure of the aortic end.…”

Aortico-Right Ventricular Tunnel with Anomalous Right Coronary Artery

“…In the report by Hruda et al, 10 magnetic resonance angiogram was used for coronary assessment in a five‐month‐old baby. CT angiogram was used as the confirming investigational modality for the first time for this condition in the report by Lin et al 14 in a 32‐year‐old patient. Ours is the first case where CT angiogram was used in an infant for this condition.…”

“…This tunnel may connect the ascending aorta above the sinotubular junction to either the left or the right ventricle. Although more than 130 cases of aorto‐left ventricular tunnel have been reported, aorto‐right ventricular tunnel (ARVT) is a rare entity and only 14 cases have been reported 1–14 . This condition presents early in life with an obligatory left to right shunt 15 .…”