Sai Krishna Cheemalapati, Baruah Dibya Kumar, Reddy Gangireddy Venkateswara, Panigrahi Nanda Kishore, Suman Kalagara, Kumar Palli Venkata Naresh
Department of Cardiothoracic & Vascular Surgery, Apollo Heart Institute, Visakhapatnam, India.
Tex Heart Inst J. 2010;37(4):480-2.
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).
主动脉-右心房通道是一种血管通道，起源于瓦尔萨尔瓦窦之一，终止于上腔静脉或右心房。根据其相对于升主动脉的走行，该通道可分为前位或后位。起源于窦管嵴上方可将该通道与瓦尔萨尔瓦窦瘤区分开来，且无心肌分支可将其与冠状动脉-心腔瘘区分开来。临床表现从无症状的心前区杂音到充血性心力衰竭不等。该病变的胚胎学背景和发病机制可归因于窦房结动脉的动脉瘤样扩张或主动脉中膜的先天性薄弱。在任何一种情况下，在体循环压力的影响下，通道可能会逐渐扩大并最终破裂进入低压的右心房。该病变通过二维超声心动图和心导管检查进行诊断。计算机断层血管造影是一种额外的非侵入性诊断工具。即使在无症状患者或分流对血流动力学无显著影响的患者中，由于存在并发症的可能性，也需要早期治疗。现有的治疗方法包括基于导管的介入治疗、在控制性低血压下进行外部结扎，或在体外循环下对患者进行手术闭合。在此，我们讨论了2例患有这种罕见异常的患者的病例。我们重点介绍了随访成像的结果（患者1）以及冠状动脉的识别和安全再植入（患者2）。
