Excerpt

A female infant, age 2 months, presented with symptoms of congestive heart failure. On examination, there was tachycardia and tachypnea. Cardiac auscultation revealed normal S1 and loud S2 with continuous murmur on the left sternal border, which propagated to the right of the sternum. Chest radiography revealed mild cardiomegaly, straightened left heart border, and a slight prominence at the right edge of the cardiac silhouette. Electrocardiogram showed sinus tachycardia with right ventricular hypertrophy. Echocardiogram showed a tunnel originating posterolaterally from the left aortic sinus and separately from the left coronary artery (Fig. 1; Videos 1 and 2 (Electronic supplementary materials 1, 2)), then it coursed posteriorly to the heart and opened into the right atrial roof near the superior vena cava (SVC). The estimated maximum pressure gradient at the right atrial end was 55 mmHg. The estimated right-ventricular systolic pressure was 65 mmHg. After the patient was stabilized, multislice computed tomography (CT) angiography was performed and confirmed the diagnosis (Fig. 2). The decision was made to close this tunnel surgically. The procedure was done off pump (Fig. 3; Video 3 (Electronic supplementary material 3)), and a purse-string suture was taken around both the aortic and atrial ends of the tunnel. A transfixion suture was passed into the body of the tunnel to ensure that the tunnel was completely sealed off. The patient was extubated 2 h after surgery and had an uneventful recovery. Postoperative Echo showed complete closure of the tunnel with no residual flow.

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