title: Aorta-right atrial tunnel.
abstract: Aorta-right atrial tunnel is a vascular channel that originates from one of the sinuses of Valsalva and terminates in either the superior vena cava or the right atrium. The tunnel is classified as anterior or posterior, depending upon its course in relation to the ascending aorta. An origin above the sinotubular ridge differentiates the tunnel from an aneurysm of the sinus of Valsalva, and the absence of myocardial branches differentiates it from a coronary-cameral fistula. Clinical presentation ranges from an asymptomatic precordial murmur to congestive heart failure. The embryologic background and pathogenesis of this lesion are attributable either to an aneurysmal dilation of the sinus nodal artery or to a congenital weakness of the aortic media. In either circumstance, progressive enlargement of the tunnel and ultimate rupture into the low-pressure right atrium could occur under the influence of the systemic pressure.The lesion is diagnosed by use of 2-dimensional echocardiography and cardiac catheterization. Computed tomographic angiography is an additional noninvasive diagnostic tool. The possibility of complications necessitates early therapy, even in asymptomatic patients or those with a hemodynamically insignificant shunt. Available treatments are catheter-based intervention, external ligation under controlled hypotension, or surgical closure with the patient under cardiopulmonary bypass.Herein, we discuss the cases of 2 patients who had this unusual anomaly. We highlight the outcome on follow-up imaging (patient 1) and the identification and safe reimplantation of the coronary artery (patient 2).
authors.affiliation: Department of Cardiothoracic & Vascular Surgery, Apollo Heart Institute, Visakhapatnam, India. csaikrishna@yahoo.com
authors.forename: Cheemalapati
authors.initials: C
authors.lastname: Sai Krishna
authors.forename: Dibya Kumar
authors.initials: DK
authors.lastname: Baruah
authors.forename: Gangireddy Venkateswara
authors.initials: GV
authors.lastname: Reddy
authors.forename: Nanda Kishore
authors.initials: NK
authors.lastname: Panigrahi
authors.forename: Kalagara
authors.initials: K
authors.lastname: Suman
authors.forename: Palli Venkata Naresh
authors.initials: PV
authors.lastname: Kumar
mesh_terms: D001011:Aorta / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures; D002648:Child; D017023:Coronary Angiography; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D006330:Heart Defects, Congenital / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008297:Male; D012092:Replantation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult