The Aorto-Ventricular Tunnels
Cardiol Young 2002; 12: 563–580 © Greenwich Medical Media Ltd. ISSN 1047-9511 Continuing Medical Education The aorto-ventricular tunnels Roxane McKay, 1 Robert H. Anderson, 2 Andrew C. Cook 2 1Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar; 2Cardiac Unit, Institute of Child Health, University College London, London, UK T IS LEVYAND COLLEAGUES , IN 1963, WHO ARE that marks the junction of the aortic valvar sinuses generally credited with the first description of with the tubular ascending aorta. At the same time, I“aortico-left ventricular tunnel”. 1 Examples of the tunnel by-passes the attachment of one of the leaf- the malformation, nonetheless, were illustrated ini- lets of the aortic valve, which is tethered distally at tially by Burchell and Edwards in 1957, 2 and by the sinutubular junction. The abnormal pathway runs Edwards in 1961. 3 The subsequent documentation into the extra-cardiac tissues as it passes from its aortic of more than 130 cases has now elucidated many fea- origin to its ventricular termination. In the majority tures of the so-called “tunnels,” including their clin- of cases, these extra-cardiac tissues are those that, ical presentation and surgical management. While normally, separate the subpulmonary infundibulum most of the abnormal channels extend between the from the aorta (Fig. 1). It is the origin of the tunnel aorta and the left ventricle, 4–79 it is now also recog- nized that some, alternatively, enter the right ventri- cle.80–91 The anatomic arrangement underscoring the malformations has been clarified by recent morpho- logical studies, 92,93 while diagnosis during fetal life has established beyond any doubt that the lesions are congenital.
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