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Aortico-left ventricular tunnel: long-term outcome after surgical repair
Insights
Early surgical correction of aortico-left ventricular tunnel in infants is crucial. Accurate echocardiography diagnosis enables timely intervention, leading to excellent outcomes and preventing long-term aortic regurgitation.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Background:
- Aortico-left ventricular tunnel is a rare congenital heart defect.
- Infantile presentation often involves murmurs and potential heart failure.
- Diagnostic challenges exist, with echocardiography evolving as a primary tool.
Purpose of the Study:
- To evaluate the diagnostic accuracy of echocardiography for aortico-left ventricular tunnel.
- To assess the outcomes of surgical correction in infants.
- To determine the impact of age at surgery on residual aortic regurgitation.
Main Methods:
- Retrospective review of four pediatric cases of aortico-left ventricular tunnel over 14 years.
- Diagnosis confirmed by echocardiography (2D and Doppler) and/or cardiac catheterization.
- Surgical correction via patch closure or direct suture.
Main Results:
- All four patients underwent successful surgical correction with no perioperative mortality.
- Mean age at operation was 11 months.
- Three patients developed trivial, asymptomatic aortic regurgitation post-surgery, with earlier repair correlating to better outcomes.
Conclusions:
- Echocardiography is highly accurate for diagnosing aortico-left ventricular tunnel in infants.
- Early surgical intervention, guided by echocardiography, leads to excellent clinical outcomes.
- Delayed repair increases the risk of significant residual aortic regurgitation.
Abstract:
Over a 14 year period, four children (three male, one female) underwent surgical correction of an aortico-left ventricular tunnel. All presented in infancy (age range 5 days to 9 months). The presenting feature was a systolic and diastolic murmur in all, one of whom developed heart failure within 2 weeks of presentation. In the first two patients, the echocardiographic findings were inconclusive and the diagnosis was confirmed at cardiac catheterization (at 10 and 23 months of age, respectively); the other two were diagnosed echocardiographically by two-dimensional and Doppler color flow imaging. All four patients underwent surgery by patch closure of the aortic end of the tunnel (three patients) or direct suture closure (one patient) and there were no deaths. The mean age at operation was 11 months. During a mean follow-up period of 71 months (range 2 to 157), three patients have clinical and echocardiographic evidence of trivial aortic valve regurgitation, which was noted in the immediate postoperative period in one and at early (less than 6 months) follow-up study in the other two. All are symptom-free, are taking no medications and are growing and developing normally. Aortico-left ventricular tunnel can be accurately diagnosed by echocardiography. In patients presenting in infancy, echocardiography also provides the necessary morphologic information to enable surgical correction without angiography. Early operation is associated with an excellent outcome, whereas repair at a later age is associated with a high incidence of residual aortic regurgitation requiring further surgery.