Author + information
- Received June 26, 2012
- Accepted July 19, 2012
- Published online January 1, 2013.
- ↵⁎Reprint requests and correspondence:
Prof. Basil D. Thanopoulos, Department of Interventional Pediatric Cardiology, Iatricon Medical Centre, Distomou 5-7, 15125, Athens, Greece
A 4-year-old boy (body weight 14 kg) was referred to our department with the clinical diagnosis of patent ductus arteriosus for further evaluation and treatment. Besides a poor weight gain (body weight below the 10th percentile for age) and frequent respiratory infections, the patient was otherwise asymptomatic. Echocardiographic evaluation showed a dilated (for age) left ventricle with normal function. A connection between the origin of the right coronary artery and the right atrium was interpreted as a congenital arteriovenous fistula. Multislice computed tomography (MSCT) showed the presence of a tunnel-like communication between the right coronary sinus and the superior part of the right atrium (Fig. 1). A narrowing was seen in the middle position of the communication. Cardiac catheterization and aortography performed under general anesthesia confirmed the findings of MSCT. The diameter of the stenosis was measured to be approximately 4.9 mm (Fig. 2A). The tunnel was entered from the aorta using a 5-F right Judkins coronary catheter. Following the formation of an arteriovenous loop, a 5-mm (waist diameter) × 4-mm (length) Amplatzer Duct Occluder II (ADO II) (St. Jude Medical, St. Paul, Minnesota) was deployed through a 5-F sheath across the narrowed part of the tunnel (Figs. 2B and 2C). After release of the occluder, selective aortography confirmed complete closure of the tunnel and absence of aortic regurgitation (Fig. 2D, Online Videos 1, 2, 3, and4). Right aortico-atrial tunnel is a rare form of congenital heart disease that more frequently originates from the left coronary sinus (1). The present report emphasizes the importance of MSCT in the accurate anatomic diagnosis of these congenital aortico-atrial communications and the role of catheter closure (to our knowledge, first in the literature in a pediatric patient) (2) as an effective and safe alternative to surgical management. The ADO II with its low-profile design and 2 disks connected by a waist was the appropriate device for this case.
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The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 26, 2012.
- Accepted July 19, 2012.
- American College of Cardiology Foundation