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Surgical anatomy of aorto-left ventricular tunnel
1Department of Paediatrics, Imperial College School of Medicine at the National Heart & Lung Institute, London, England, UK. yen.ho@ic.ac.uk
Background:
Owing to the rarity of aorto-left ventricular tunnel, surgical experience with this condition is generally limited. The anatomic configuration remains to be clarified in the light of better understanding of the normal aortic root.
Methods:
Two autopsied hearts with aorto-left ventricular tunnel were examined and compared with four normal heart specimens. The normal hearts were sectioned in a variety of planes to display the ventriculoarterial junction.
Results:
The leaflets of the pulmonary valve in both normal and abnormal hearts have semilunar attachments to a sleeve of freestanding ventricular musculature, the infundibulum. An extensive fibrofatty tissue plane then interposes between the freestanding infundibulum and the aortic sinuses. The aorto-left ventricular tunnels in the abnormal hearts pass within this tissue plane. The aortic orifice of the tunnel is distal to the level of the sinutubular junction, whereas the ventricular orifice is located within the interleaflet triangle between the right and left aortic sinuses.
Conclusions:
Aorto-left ventricular tunnels bypass the normal ventriculoarterial junction but do not penetrate the septal musculature. This has implications for the fine-tuning of surgical repair.