TY - JOUR
T1 - Surgical Management of Aorto-Ventricular Tunnel. A Multicenter Study
AU - the European Congenital Heart Surgeons Association-World Society for Pediatric and Congenital Heart Surgery (ECHSA-WSPCHS) Study Group
AU - Protopapas, Eleftherios M.
AU - Anderson, Robert H.
AU - Backer, Carl L.
AU - Fragata, José
AU - Hakim, Nicolas
AU - Vida, Vladimiro L.
AU - Sarris, George E.
AU - Barron, David J.
AU - Berggren, Håkan
AU - Hazekamp, Mark G.
AU - Ilyin, Vladimir
AU - Kornoukhov, Oleg J.
AU - Kostolny, Martin
AU - Lazarov, Stojan
AU - Lo Rito, Mauro
AU - Monge, Michael C.
AU - Mykychak, Yaroslav
AU - Nosal, Matej
AU - Prêtre, René
AU - Polimenakos, Anastasios C.
AU - Sojak, Vladimir
AU - Stellin, Giovanni
AU - Veshti, Altin
AU - Yemets, Illya
N1 - Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - Aorto-ventricular tunnel (AoVT), a rare congenital anomaly, is a channel originating in the ascending aorta just above the sinotubular junction and leading to the cavity of the left ventricle (AoLVT), or, rarely, the right (AoRVT). This study reviews our collective 30-year experience with the surgical treatment of AoVT. Data were submitted by 15 participating centers on 42 patients who underwent correction of AoVT between 1987 and 2018. Of these, 36 had AoLVT, and 6 AoRVT. The tunnel originated above the right coronary sinus in 28 (77.8%) patients. For AoLVT, most operations were performed early (median age 25 days, range: 1 day–25 years). In contrast, AoRVT was diagnosed and repaired later (median age 6 years, range: 1 month–12 years). Surgically important coronary ostial displacement was common. Patch closure of the aortic orifice only was the commonest surgical repair for AoLVT (23 patients), while in AoRVT, both orifices or only the ventricular one was closed. Aortic valvar insufficiency, severe or moderate, coexisted in 11 (30.5%) patients with AoLVT, and aortic valvuloplasty was performed in 8, mainly due to aortic valve stenosis. Aortic valvar insufficiency at discharge ranged from trivial to mild in almost all patients. Early mortality was 7.14%, with 3 patients with AoLVT succumbing to cardiac failure. There were 2 early reoperations and 1 late death. AoVT is a rare malformation. AoLVT usually necessitates surgery in early life. AoRVT is rarer, diagnosed and repaired later in life. Surgical repair by patch closure, with concomitant aortic valve repair as needed, is associated with good results.
AB - Aorto-ventricular tunnel (AoVT), a rare congenital anomaly, is a channel originating in the ascending aorta just above the sinotubular junction and leading to the cavity of the left ventricle (AoLVT), or, rarely, the right (AoRVT). This study reviews our collective 30-year experience with the surgical treatment of AoVT. Data were submitted by 15 participating centers on 42 patients who underwent correction of AoVT between 1987 and 2018. Of these, 36 had AoLVT, and 6 AoRVT. The tunnel originated above the right coronary sinus in 28 (77.8%) patients. For AoLVT, most operations were performed early (median age 25 days, range: 1 day–25 years). In contrast, AoRVT was diagnosed and repaired later (median age 6 years, range: 1 month–12 years). Surgically important coronary ostial displacement was common. Patch closure of the aortic orifice only was the commonest surgical repair for AoLVT (23 patients), while in AoRVT, both orifices or only the ventricular one was closed. Aortic valvar insufficiency, severe or moderate, coexisted in 11 (30.5%) patients with AoLVT, and aortic valvuloplasty was performed in 8, mainly due to aortic valve stenosis. Aortic valvar insufficiency at discharge ranged from trivial to mild in almost all patients. Early mortality was 7.14%, with 3 patients with AoLVT succumbing to cardiac failure. There were 2 early reoperations and 1 late death. AoVT is a rare malformation. AoLVT usually necessitates surgery in early life. AoRVT is rarer, diagnosed and repaired later in life. Surgical repair by patch closure, with concomitant aortic valve repair as needed, is associated with good results.
KW - Aorto-ventricular tunnel
KW - Surgical treatment
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U2 - 10.1053/j.semtcvs.2020.01.011
DO - 10.1053/j.semtcvs.2020.01.011
M3 - Article
C2 - 32057970
AN - SCOPUS:85081214069
SN - 1043-0679
VL - 32
SP - 271
EP - 279
JO - Seminars in thoracic and cardiovascular surgery
JF - Seminars in thoracic and cardiovascular surgery
IS - 2
ER -