A case of aorta-right atrial tunnel presented with an asymptomatic murmur

Abstract

Aorta-right atrial tunnel is a rare and distinct congenital anomaly. It is a vascular channel that originates from one of the sinuses of Valsalva with a tortuous course anterior or posterior to the ascending aorta, and terminates either in the superior vena cava or in the right atrium (RA). We report a 42-year-old female briefly with aorta-right atrial tunnel in which the left coronary artery arose from the tunnel and terminated into the RA.

Keywords: Aorta; Coronary angiography; Coronary vessel anomalies; Right atrium.

Fig. 1

Transthoracic echocardiography and Doppler show a tunnel-like structure with continuous Doppler signals (arrows) from the left coronary sinus to the right atrium (A, B, C and E). In addition, a continuous turbulent systolic and diastolic flow pattern is noted (D, white arrows).

Fig. 2

Coronary angiography reveals the normal left coronary artery (LCA) (A), and there is a large tunnel-like structure beginning in the left coronary sinus, and terminating in the body of right atrium (B and C). The tunnel shows aneurysmal dilatation, and the LCA arises separately from the tunnel (C). Right coronary artery originates from right coronary cusp (D).

Fig. 3

Cardiac-computed tomography shows the tunnel (black arrows) taking its origin from the aortic root (A), then passing posterior to the aortic root (B) and entering the right atrium through a tortuous link (A).