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Surgical Management of Aorto-Ventricular Tunnel. A Multicenter Study.
- Source :
-
Seminars in thoracic and cardiovascular surgery [Semin Thorac Cardiovasc Surg] 2020 Summer; Vol. 32 (2), pp. 271-279. Date of Electronic Publication: 2020 Feb 10. - Publication Year :
- 2020
-
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.<br /> (Copyright © 2020 Elsevier Inc. All rights reserved.)
- 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
Subjects
Details
- Language :
- English
- ISSN :
- 1532-9488
- Volume :
- 32
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Seminars in thoracic and cardiovascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 32057970
- Full Text :
- https://doi.org/10.1053/j.semtcvs.2020.01.011