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Aortico-right ventricular tunnel and critical pulmonary stenosis: Diagnosis by two-dimensional and Doppler echocardiography and angiography


An infant with aortico-right ventricular (AO-RV) tunnel and critical pulmonary stenosis presented with severe distress at birth. We present the clinical, echocardiographic, and angiographic features, correlated with autopsy findings. Also we discuss the differentiation from other AO-RV communications and a theory for the embryogenesis. AO-RV tunnel should be considered in the differential diagnosis of a critically sick newborn with cyanosis, a “to and fro” murmur, and signs of right heart failure. The correct diagnosis can be made echocardiographically by demonstrating the two ends of the tunnel connecting the aorta and a dilated RV, two normal coronary arteries, and obtaining high-velocity systolic and diastolic Doppler flow signals in the tunnel. Surgical repair of this lesion is possible, and early diagnosis and a modification of the surgical procedure may help survival.

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  1. 1.

    Bharati S, Lev M, Cassels DE (1973) Aortico-right ventricular tunnel.Chest 63:198–202

    CAS  PubMed  Google Scholar 

  2. 2.

    Emmanouilides GC, Bayleu BG (1983) Congenital absence of the pulmonary valve. In: Adams FH, Emmanouilides GC (eds)Moss heart disease in infants, children and adolescents 1983, 3rd edn. William and Wilkins, Baltimore, pp 228–234

    Google Scholar 

  3. 3.

    Freedom RM, Harrington DP (1974) Contributions of intramyocardial sinusoids in pulmonary atresia and intact ventricular septum to a right sided circular shunt.Br Heart J 36:1061–1065

    CAS  PubMed  Google Scholar 

  4. 4.

    Grant P, Abrams LD, DeGiovanni JV, Shah K, Silove ED (1985) Aortico-left ventricular tunnel arising from the left sinus.Am J Cardiol 55:1657–1658

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    Humes RA, Hagler DJ, Julsrud PR, Levy JM, Feldt RH, Schaff HV (1986) Aortico-left ventricular tunnel: diagnosis based on two-dimensional echocardiography, color flow Doppler imaging and magnetic resonance imaging.Mayo Clin Proc 61:901–907

    CAS  PubMed  Google Scholar 

  6. 6.

    Kanter K, Pennington DG, Nouri S, Chen SC, Jureidini S, Balfour I (1987) Concomitant valvotomy and subclavian main pulmonary shunt in neonates with pulmonary atresia and intact ventricular septum.Ann Thorac Surg 43:490–494

    CAS  PubMed  Google Scholar 

  7. 7.

    Levy MJ, Lillehie CW, Anderson RC, Amplatz IC, Edwards JE (1963) Aortico-left ventricular tunnel.Circulation 27:841–853

    Google Scholar 

  8. 8.

    Nihoyannopoulos P, Sapsford R, Oakley CM (1987) Congenital fistula between the aorta and left atrium.Br Heart J 57:387–390

    CAS  PubMed  Google Scholar 

  9. 9.

    Perry JC, Nanda NC, Hicks DG, Harris JP (1983) Two-dimensional echocardiographic identification of aortico-left ventricular tunnel.Am J Cardiol 52:913–914

    CAS  PubMed  Google Scholar 

  10. 10.

    Rosenberg H, Williams WG, Trusler GA, Smallhorn J, Rowe RD, Moes CAF, Freedom RM (1986) Congenital aortico-right atrial communications: the dilemma of differentiation from coronary camera fistula.J Thorac Cardiovasc Surg 91:841–847

    CAS  PubMed  Google Scholar 

  11. 11.

    Yoshikawa J, Kato H, Yanogihara K, Takagi Y, Okumachi F, Yoshida K, Tomita K, Fukaya T, Baba K (1982) Non-invasive visualization of the dilated main coronary artery fistulas by cross-sectional echocardiography.Circulation 2:145–149

    Google Scholar 

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Correspondence to Saadeh B. Jureidini.

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Jureidini, S.B., de Mello, D., Nouri, S. et al. Aortico-right ventricular tunnel and critical pulmonary stenosis: Diagnosis by two-dimensional and Doppler echocardiography and angiography. Pediatr Cardiol 10, 99–103 (1989).

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Key words

  • Aortico-right ventricular tunnel
  • Pulmonary stenosis
  • Angiography
  • Echocardiography