Aortico right atrial tunnel - Clinical presentation, transcatheter management, and follow-up from a large cohort of patients.

IF 0.9 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Annals of Pediatric Cardiology Pub Date : 2024-01-01 Epub Date: 2024-05-24 DOI:10.4103/apc.apc_1_24
Kothandam Sivakumar, Anil Kumar Singhi, Ramkishore Sankarakuttalam, Monica Rajendran
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引用次数: 0

Abstract

Background: Aortico right atrial tunnel (ARAT) is a rare extracardiac communication between the aorta and the right atrium with two anatomical types. A recent global review identified 59 patients.

Methods: Patients with ARAT from two centers were analyzed for their demographics, symptoms, morphology, management, and follow-up thromboprophylaxis.

Results: Among 21 patients including 8 males with a median age of 3 years (18 days-72 years) diagnosed as ARAT, 12 (57%) had posterior tunnels and 9 had anterior tunnels. Four patients had multiple exits. Eighteen tunnels were closed after arteriovenous circuit formation. Six patients (29%) weighing <10 kg presented early with heart failure. Transcatheter closure normalized the hemodynamics including in one infant after failed surgery. Two elderly patients (10%) above 60 years presented with angina and atrial fibrillation. The rest were asymptomatic. Occluders were positioned in the narrow proximal aortic end of the tunnel in all except two patients, where the distal atrial end was closed. All procedures were successful without complications. There was one late death after 1 year from subarachnoid hemorrhage. At a median follow-up of 96 months, all survivors were asymptomatic. Thromboprophylaxis with dual antiplatelets for 1-2 years followed earlier was recently changed to aspirin with Coumadin. Complete remodeling occurred when the proximal aortic end was closed, but partial persistence of the track was noted after distal closure.

Conclusions: This largest cohort of ARAT showed the safety and efficacy of transcatheter closure even in neonates. The narrow proximal aortic end should be the target for closure rather than the distal atrial end to achieve complete remodeling.

主动脉右心房隧道--临床表现、经导管治疗和大量患者的随访。
背景:主动脉右心房隧道(ARAT)是主动脉和右心房之间一种罕见的心外沟通,有两种解剖类型。最近的一项全球研究发现了 59 名患者:方法:对来自两个中心的 ARAT 患者的人口统计学、症状、形态学、管理和后续血栓预防措施进行了分析:结果:在21名被诊断为ARAT的患者中,包括8名男性,中位年龄为3岁(18天-72岁),其中12人(57%)有后隧道,9人有前隧道。四名患者有多个出口。18 条隧道在形成动静脉回路后关闭。六名患者(29%)进行了称重:这组最大规模的 ARAT 患者表明,即使是新生儿,经导管封堵术也是安全有效的。狭窄的主动脉近端应作为关闭的目标,而不是远端心房端,以实现完全重塑。
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来源期刊
Annals of Pediatric Cardiology
Annals of Pediatric Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
1.40
自引率
14.30%
发文量
51
审稿时长
23 weeks
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