Surgical Management of Aorto-Ventricular Tunnel. A Multicenter Study

Protopapas, Eleftherios; Anderson, Robert H.; Backer, Carl L.; Fragata, José; Hakim, Nicolas; Vida, Vladimiro L.; Sarris, George E.; Barron, David J.; Berggren, Håkan; Hazekamp, Mark G.; Ilyin, Vladimir; Kornoukhov, Oleg J; Kostolny, Martin; Lazarov, Stojan; Rito, Mauro Lo; Mongé, Michael C.; Mykychak, Yaroslav; Nosál, Matej; Prêtre, René; Polimenakos, Anastasios C.; Stellin, Giovanni; Veshti, Altin; Yemets, Illya

doi:10.1053/j.semtcvs.2020.01.011

Cited by 11 publications

(42 citation statements)

References 18 publications

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“…95 In those with right ventricular tunnels, the median age at diagnosis was six years (1 month-12 years). 95 The lesions are found more frequently in males, with a male-to-female ratio of 2.5:1. 95 Among patients reported, it was not possible to identify any regional or ethnic predominance, and none were reported in the setting of isomerism (Supplemental Tables E1 and E2).…”

Section: Resultsmentioning

confidence: 99%

“…5,9,14,15,18,39 –52,95 The specific anomalies reported include atresia of arterial orifice and origin of the artery involved from the proximal or distal end of the tunnel. 5,9,14,15,18,39 –52,95 More than two orifices, a single or stenotic orifice, and an intramural course of the coronary artery in the posterior wall of the tunnel have all been observed. 9,10,18,95 Other reported associated anomalies include aneurysms of the interventricular septum, ventricular septal defect, so-called “left ventricular noncompaction,” and transposition in a solitary case.…”

Section: Resultsmentioning

confidence: 99%

“…5,9,14,15,18,39 –52,95 More than two orifices, a single or stenotic orifice, and an intramural course of the coronary artery in the posterior wall of the tunnel have all been observed. 9,10,18,95 Other reported associated anomalies include aneurysms of the interventricular septum, ventricular septal defect, so-called “left ventricular noncompaction,” and transposition in a solitary case. 11 –13,42,50,83,93…”

Section: Resultsmentioning

confidence: 99%

“…A few investigators have performed external plication using multiple pledgeted sutures. 30,35,36,73,76,95…”

Section: Resultsmentioning

confidence: 99%

“…These were then incorporated, as far as possible, with the results of the retrospective study emanating from the Joint Multicenter Registry, which collected the findings from 42 patients, and was carried out under the auspices of the European Congenital Heart Surgeons Association and the World Society for Pediatric and Congenital Heart Surgery. 95 We have then synthesized the overall data to outline any issues of concern, clues for both pre- and postnatal diagnosis, and the therapeutic options for repair of the primary as well as concomitant anomalies, hoping to improve future surgical management. Due to the small sample sizes, the heterogeneity of the clinical state at the time of surgical intervention, and the difficulties in the selection of appropriate cardiac quantifiable end points, we were unable to perform a meta-analysis.…”

Section: Methodsmentioning

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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Section: Resultsmentioning

confidence: 99%