title: Transesophageal Echocardiography for the Evaluation of Aorto-Left Ventricular Tunnel in Adults, with Follow-ups.
abstract: OBJECTIVE
  This study aims to compare the diagnostic accuracy of combined two-dimensional (2D) and real time three-dimensional (RT3D) transesophageal echocardiogram (TEE) imaging with the anatomic findings during surgery in adults with aorto-left ventricular tunnel (ALVT).
  
  
  BACKGROUND
  ALVT has typically been reported in infants rather than in adults. TEE appears to be a promising method of recognizing the spatial relationship of intracardiac structures.
  
  
  METHODS
  Patients underwent comprehensive 2D and RT3DTEE within 1 week preoperative and intraoperative. The TEE images were compared with the surgical findings.
  
  
  RESULTS
  Nine patients diagnosed with ALVT using TEE were selected. The operations were successfully performed in 8 patients. The origin of the tunnels diagnosed by TEE was superior to the right coronary sinus (RCS) in 3 patients, superior to the commissure of the left coronary sinus (LCS) and the RCS in 3 patients, inferior to the junction of the LCS and noncoronary sinus (NCS) in 2 patients, and superior to the NCS in 1 patient. The surgical findings confirmed ALVT in 8 patients. The average diameter of the tunnel orifices in the LV or in the aorta measured by TEE versus surgery was 6.15 ± 3.21 mm versus 6.80 ± 3.91 mm (correlation displayed as r = 0.99, P < 0.0001). Seven (78%) patients had mild to severe aortic regurgitation, and 6 (67%) patients had mitral regurgitation.
  
  
  CONCLUSIONS
  A combination of 2D and RT3DTEE imaging modalities would be needed to optimally define the anatomy and functional consequences of ALVT in adults.
authors.affiliation: Department of Ultrasound, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Hongmei
authors.initials: H
authors.lastname: Xia
authors.affiliation: Department of Ultrasound, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Ultrasound, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Yali
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Pathology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Jinliang
authors.initials: J
authors.lastname: Tang
authors.affiliation: Department of Ultrasound, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Yunhua
authors.initials: Y
authors.lastname: Gao
mesh_terms: D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging* / Q000601:surgery; D000328:Adult; D001011:Aorta / Q000002:abnormalities* / Q000000981:diagnostic imaging* / Q000601:surgery; D003199:Computer Systems; D019560:Echocardiography, Three-Dimensional / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D055815:Young Adult
keywords: adults; aorto-left ventricular tunnel; real time three-dimensional; transesophageal echocardiography; two-dimensional