Ma Xiaochun, Li Jinzhang, Zhang Qian, Kong Xiangqian, Yuan Guidao, Wang Zhengjun, Zou Chengwei
Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong University, No.324 Jingwu Road, Shandong, 250021, People's Republic of China.
School of Medicine, Shandong University, No.44 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China.
J Cardiothorac Surg. 2018 Jun 28;13(1):81. doi: 10.1186/s13019-018-0770-1.
Aorto-left ventricular tunnel (ALVT) is a rare congenital extracardiac channel that connects the ascending aorta to the left ventricle. To our knowledge, no case has been thus far reported as ALVT with both anomalous origin of right coronary artery (AORCA) and bicuspid aortic valve (BAV).
We reported a case of a 5-year-old female diagnosed as ALVT with accompanying AORCA and BAV which had been previously misdiagnosed as aortic regurgitation (AR) triggered by BAV. Additionally, a special modality of ALVT was confirmed in this case during the surgery in which the tunnel was formed by the separation between the roots of two aortic leaflets during the diastolic period.
ALVT with both AORCA and BAV is clinically uncommon and the aberrant tunnel in ALVT can be formed by the gap between the roots of two aortic leaflets. Besides, ALVT with BAV might easily lead to an inaccurate diagnose as aortic regurgitation caused by BAV. Cardiac surgeons should be alerted for differential diagnosis of ALVT with BAV and isolated bicuspid aortic valve (BAV) causing aortic regurgitation (AR).
主动脉-左心室隧道（ALVT）是一种罕见的先天性心外通道，它将升主动脉与左心室相连。据我们所知，迄今为止尚无同时合并右冠状动脉异常起源（AORCA）和二叶式主动脉瓣（BAV）的ALVT病例报道。
我们报告了一例5岁女性患者，诊断为ALVT，同时伴有AORCA和BAV，该病例此前被误诊为由BAV引发的主动脉反流（AR）。此外，在手术过程中证实了该病例中ALVT的一种特殊形式，即隧道是在舒张期由两个主动脉瓣叶根部之间的分离形成的。
同时合并AORCA和BAV的ALVT在临床上并不常见，ALVT中的异常隧道可由两个主动脉瓣叶根部之间的间隙形成。此外，伴有BAV的ALVT可能容易被误诊为由BAV引起的主动脉反流。心脏外科医生应警惕对伴有BAV的ALVT与孤立性二叶式主动脉瓣（BAV）导致的主动脉反流（AR）进行鉴别诊断。
