Aorto-Left Ventricular Tunnel With Intraoperative Right Coronary Artery Occlusion: A Surgical Perspective

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This video presents the surgical management of an aorto-left ventricular tunnel (ALVT) in an 11-month-old infant, a rare congenital anomaly characterized by an abnormal extracardiac communication between the ascending aorta and the left ventricular cavity. The patient presented with recurrent respiratory tract infections and failure to thrive. Preoperative imaging confirmed the diagnosis of ALVT but failed to visualize the right coronary artery (RCA).  

Intraoperatively, the RCA ostium was found to be completely occluded, with retrograde perfusion observed via the left coronary artery, a critical finding that significantly altered surgical planning.  

The ALVT was repaired using polytetrafluoroethylene (PTFE) patches, with meticulous care taken to preserve aortic valve function. Postoperative recovery was uneventful, and follow-up imaging showed no residual shunt or regurgitation. This case underscores the importance of intraoperative vigilance in congenital heart surgery and highlights how surgical exploration can reveal critical anomalies missed during preoperative evaluation. 

References

1. Berber N, Lugones I. Aortic left ventricular tunnel: A case report of early presentation. Argentine Journal of Cardiovascular Surgery. 2021;19(3):82-84.
2. Gajjar T, Voleti C, Matta R, Iyer R, Dash PK, Desai N. Aorta-right atrial tunnel: Clinical presentation, diagnostic criteria, and surgical options. J Thorac Cardiovasc Surg. 2005;130(5):1287-92.
3. Paul SK, Gajjar TP, Desai NB. Aorto-left atrial tunnel: A rare entity. Ann Thorac Surg. 2013;95:e121-2.
4. Diraneyya OM, Alhabshan F, Alghamdi A, Moafa H, Alnasef M, Kabbani MS. Aorto-left ventricular tunnel: Case series of a rare disease. Cardiol Young. 2021;31(1):47-51.
5. Diwakar A, Chalam KS, Hiremath CS, Manohar K, Dash PK. Aorto-left ventricular tunnel – A case report. Ann Card Anaesth. 2020;23(1):98-9.
6. McKay R. Aorto-ventricular tunnel. Orphanet J Rare Dis. 2007;2:41.

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