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Aorta-Right Atrial Tunnel: An Interesting Type of a Congenital Coronary Artery Anomaly

, MD, , MD, , MD, , MD

Korean Circulation Journal

The Korean Society of Cardiology

Coronary vessel anomalies, Fistula, Aneurysm

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      Abstract

      An 18-year-old girl with an aortico-right atrial tunnel originating from the left sinus of Valsalva, in which the left anterior descending and circumflex coronary arteries arose independently from the different parts of the tunnel, was reported. In the differential diagnosis of continuous murmur, this type of tunnel should be taken into consideration. Surgical approach should be offered.

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      Aorta-right atrial tunnel: clinical presentation, diagnostic criteria, and surgical options.

      Aorta-right atrial tunnel is a rare and distinct congenital anomaly. To the spectrum of aorta-right atrial communications, we want to add this separate entity of aorta-right atrial tunnel by presenting the clinical features, morphologic aspects, diagnostic criteria, surgical techniques, and outcome in various clinical settings for better understanding of this developmentally intriguing, clinically complex, and therapeutically challenging disorder. From June 1994 through October 2004, 9 patients were treated for aorta-right atrial tunnel at our institution. Ages ranged from 9 to 45 years. There were 5 male subjects and 4 female subjects. Morphologically, 2 types of tunnels were identified in relationship to the ascending aorta: the anterior type in 3 patients and the posterior type in 6 patients. In all patients the diagnosis was established by means of 2-dimensional echocardiography and transesophageal echocardiography and confirmed by means of angiography. Eight patients were treated surgically, and 1 patient was treated with coil embolization. Postoperative echocardiograms obtained for all patients before discharge confirmed complete obliteration of the tunnel. One patient died perioperatively, and the other 8 patients were discharged in stable condition. During follow-up at 3 months, 6 months, and 1 year, all patients were in New York Heart Association class I, and echocardiography showed no residual shunts. In patients with aorta-right atrial tunnel, 2-dimensional echocardiography and transesophageal echocardiography are enough to establish clinical diagnosis, but ascending aortography is necessary to differentiate from more common clinical conditions, like ruptured sinus of Valsalva aneurysm and coronary cameral fistula. The rarity of this condition is established by the fact that during the same period of time, we have treated in our institution 66 cases of ruptured sinus of Valsalva aneurysm, which is the most common aorta-right atrial communication. Treatment options are simple ligation or ligation with implantation of coronary ostium or coil embolization. The location of the coronary ostium dictates technical details. Follow-up reveals excellent functional recovery.
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        Aorta-right atrial tunnel.

        Aorta-right atrial tunnel is rare. We report a case of aorta-right atrial tunnel in which the right coronary artery arose from the tunnel. Successful surgical treatment was performed.
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          Aorta--right atrial communication. Report of an unusual case.

          An unusual aneurysmal aorta--right atrial communication was found in a 25-year-old man with a rounded mass in the right cardiophrenic angle. Differential diagnoses included ruptured aneurysm of the sinus of Valsalva, coronary arteriovenous fistula, rupture of a dissecting aneurysm of the ascending aorta into the right atrium, and pseudoaneurysm of the right coronary artery followed by formation of a fistula between the aneurysm and the right atrium. Closure of the communication was performed under cardiopulmonary bypass. Complete absence of the right superior vena cava with a large persistent left superior vena cava draining to the coronary sinus was an unexpected finding at operation. The origin of the communication is not known; possible anomalous coronary and noncoronary origins are considered.
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            Author and article information

            Affiliations
            Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Etlik, Ankara, Turkey.
            Author notes
            Correspondence: Murat Celik, MD, Department of Cardiology, Gulhane School of Medicine, 06018 Etlik-Ankara, Turkey. Tel: 90-312-3044261, Fax: 90-312-3044250, drcelik00@ 123456hotmail.com
            Journal
            Korean Circ J
            Korean Circ J
            KCJ
            Korean Circulation Journal
            The Korean Society of Cardiology
            1738-5520
            1738-5555
            May 2014
            20 May 2014
            : 44
            : 3
            : 193-195
            4037643
            10.4070/kcj.2014.44.3.193
            Copyright © 2014 The Korean Society of Cardiology

            This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

            Categories
            Case Report

            Cardiovascular Medicine

            coronary vessel anomalies, fistula, aneurysm

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