A Review of the Surgical Management of Aorto-ventricular Tunnels.
Ujjwal Kumar ChowdhuryRobert H AndersonNiwin GeorgeSukhjeet SinghLakshmi Kumari SankhyanDoniparthi PradeepAbhinavsingh ChauhanSanjoy SenguptaPrateek VaswaniPublished in: World journal for pediatric & congenital heart surgery (2021)
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.
Keyphrases
- aortic stenosis
- left ventricular
- aortic valve
- aortic valve replacement
- transcatheter aortic valve implantation
- transcatheter aortic valve replacement
- ejection fraction
- mitral valve
- hypertrophic cardiomyopathy
- acute myocardial infarction
- magnetic resonance imaging
- cardiac resynchronization therapy
- heart failure
- left atrial
- pulmonary hypertension
- end stage renal disease
- coronary artery
- coronary artery disease
- risk factors
- pulmonary artery
- randomized controlled trial
- minimally invasive
- computed tomography
- type diabetes
- pregnant women
- newly diagnosed
- healthcare
- chronic kidney disease
- cardiovascular disease
- patients undergoing
- peritoneal dialysis
- preterm infants
- early onset
- contrast enhanced
- patient reported outcomes
- adipose tissue
- coronary artery bypass
- cardiovascular events
- health information