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Surgical treatment of aortico-left ventricular tunnel
P Horváth1, S Balaji, S Skovránek
1Kardiocentrum Motol, Prague, Czechoslovakia.
Insights
Surgical repair of aortico-left ventricular tunnel effectively treats this congenital heart defect, with most surviving children leading normal lives post-operation. Early diagnosis and intervention are crucial for favorable outcomes in pediatric patients.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Background:
- Aortico-left ventricular tunnel (ALVT) is a rare congenital heart defect characterized by an abnormal communication between the aorta and the left ventricle.
- Patients often present with severe symptoms, including congestive heart failure, particularly in neonates.
- Associated findings include left ventricular hypertrophy and specific electrocardiogram (ECG) and chest X-ray abnormalities.
Purpose of the Study:
- To report the surgical experience and long-term outcomes of children treated for aortico-left ventricular tunnel.
- To evaluate the diagnostic modalities and surgical techniques employed in managing ALVT.
- To assess the functional status and quality of life in survivors.
Main Methods:
- Retrospective review of 13 pediatric patients operated on for ALVT since 1971.
- Diagnostic methods included physical examination, ECG, chest X-ray, echocardiography (2DE) with Doppler sonography, and angiography.
- Surgical repair involved closure of the tunnel at one or both ends.
Main Results:
- Thirteen children (age range 6 hours to 11 years) underwent surgery for ALVT.
- Echocardiography and Doppler sonography were key in diagnosing the tunnel and associated massive regurgitation.
- The majority of tunnels originated from the right coronary sinus.
- Surgical outcomes were generally favorable, with one early postoperative death and one late non-cardiac death.
- Follow-up echocardiography showed mild to moderate aortic incompetence in some patients, but all survivors led normal lives.
Conclusions:
- Surgical correction of aortico-left ventricular tunnel is effective in treating this complex congenital heart anomaly.
- Early diagnosis and timely surgical intervention are critical for improving patient outcomes.
- Long-term follow-up indicates that most surviving children achieve a normal quality of life after successful repair.
Abstract:
Thirteen children (age range 6 h-11 years, median 4 months) operated upon for aortico-left ventricular tunnel since 1971 are reported. All patients had systolic and diastolic murmurs, 4 of 5 neonates were in severe congestive heart failure. Twelve children had left ventricular hypertrophy on ECG with an ischaemic pattern in the neonates. Chest X-ray revealed cardiomegaly with a broad upper mediastinal shadow from the enlarged aorta. Echocardiography (2DE) revealed a tubular communication between the aorta and the left ventricle bypassing the aortic valve and massive regurgitation through this tunnel demonstrated by Doppler sonography. In 8 patients, the diagnosis was confirmed by angiography. The tunnel arose from the right coronary sinus in 12 and from the left coronary sinus in 1 patient. The tunnel was closed at both ends in 8, at the aortic end only in 3 and at the ventricular end in the remaining 2 cases. One 6-day-old infant, operated upon in 1971 died postoperatively. There was 1 non-cardiac related late death due to a brain tumour. Echocardiographic analysis of left ventricular size and function was carried out in 9 children up to 39 months after surgery. Mild to moderate aortic incompetence was detected during the follow-up period in 2 of 12 patients. All surviving children are leading normal lives.