Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China.
Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China.
Cardiovasc Ultrasound. 2023 Apr 1;21(1):5. doi: 10.1186/s12947-023-00303-x.
Aorto-ventricular tunnel (AVT) is an abnormal communication channel between the ascending aorta and the ventricle. It commonly has two orifices, i.e., one aortic opening and one ventricular opening. In this study, we present a unique case of AVT with three orifices: one aortic opening, one LV opening, and one RV opening.
A 64-year-old male presented with chest discomfort and dyspnea on exertion lasting the past six months. Physical examination revealed a grade 4/6 continuous biphasic murmur along the left sternal edge and a grade 3/6 systolic murmur at the apex. Transthoracic echocardiography (TTE) demonstrated: (1) an AVT with three orifices, i.e., one aortic opening, one LV opening, and one RV opening. The LV and RV openings were located in the left and right ventricular outflow tracts, respectively. (2) The aortic valve (AV) was calcified with a small aneurysm at the non-coronary cusp. (3)The mitral valve (MV) chordal rupture of the P2 and P3 segments was observed in the posterior leaflet with severe eccentric regurgitation. Subsequent coronary computed tomography angiography (CTA) further confirmed the diagnosis of AVT with three openings, and clarified the coronary arteries normally arose from the aortic sinuses. The patient was then referred for surgical treatment, consisting of closure of three AVT orifices, AV replacement, and MV replacement. Six months following surgery, the patient was asymptomatic. TTE demonstrated normal mechanic AV and MV function, and there was no residual shunt among the ascending aorta, LV and RV.
It is the first case to report an AVT with three orifices. This paper described the entire process from diagnosis to treatment of this unique case, thus providing some novel insights into AVT.
主动脉-心室隧道（AVT）是升主动脉和心室之间异常的通道。它通常有两个口，即一个主动脉口和一个心室口。在本研究中，我们报告了一个具有三个口的 AVT 的独特病例：一个主动脉口、一个 LV 口和一个 RV 口。
一名 64 岁男性因过去六个月持续出现胸痛和劳力性呼吸困难而就诊。体格检查发现胸骨左侧缘有 4/6 级连续双期杂音和心尖处 3/6 级收缩期杂音。经胸超声心动图（TTE）显示：（1）具有三个口的 AVT，即一个主动脉口、一个 LV 口和一个 RV 口。LV 和 RV 口分别位于左、右心室流出道。（2）主动脉瓣（AV）钙化，无冠状动脉瓣有小动脉瘤。（3）二尖瓣（MV）后叶 P2 和 P3 节段腱索断裂，伴有严重偏心反流。随后的冠状动脉计算机断层血管造影（CTA）进一步证实了具有三个口的 AVT 的诊断，并明确了冠状动脉正常起源于主动脉窦。随后患者被转诊接受手术治疗，包括关闭三个 AVT 口、AV 置换和 MV 置换。手术后 6 个月，患者无症状。TTE 显示机械性 AV 和 MV 功能正常，升主动脉、LV 和 RV 之间无残余分流。
这是首例报告具有三个口的 AVT 的病例。本文描述了这个独特病例从诊断到治疗的整个过程，为 AVT 提供了一些新的见解。
