1. Surgical Management of Aorto-Ventricular Tunnel. A Multicenter Study.
- Author
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Protopapas EM, Anderson RH, Backer CL, Fragata J, Hakim N, Vida VL, Sarris GE, Barron DJ, Berggren H, Hazekamp MG, Ilyin V, Kornoukhov OJ, Kostolny M, Lazarov S, Lo Rito M, Monge MC, Mykychak Y, Nosal M, Prêtre R, Polimenakos AC, Sojak V, Stellin G, Veshti A, and Yemets I
- Subjects
- Adolescent, Adult, Aorta abnormalities, Aorta diagnostic imaging, Aorta physiopathology, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Child, Child, Preschool, Europe, Female, Heart Defects, Congenital diagnostic imaging, Heart Defects, Congenital mortality, Heart Defects, Congenital physiopathology, Heart Ventricles abnormalities, Heart Ventricles diagnostic imaging, Heart Ventricles physiopathology, Hemodynamics, Humans, Infant, Infant, Newborn, Male, Postoperative Complications mortality, Postoperative Complications surgery, Recovery of Function, Retrospective Studies, Time Factors, Treatment Outcome, United States, Ventricular Function, Left, Young Adult, Aorta surgery, Aortic Valve surgery, Cardiac Surgical Procedures adverse effects, Cardiac Surgical Procedures mortality, Heart Defects, Congenital surgery, Heart Ventricles surgery
- Abstract
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., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2020
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