Congenital Descending Aorta-Right Atrial Tunnel: A Case Report

Abstract

Introduction: Congenital descending aorta-right atrial tunnel is a rare congenital heart defect. Herein, a new case successfully treated by transcatheter closure using a new type of ventricular septal defect occluder from the aortic side was reported. Case Presentation: An 11-month-old Chinese girl presenting with a cardiac murmur was suspected with partial anomalous pulmonary venous connection as assessed by echocardiography. Descending aorta-right atrial tunnel was confirmed by computed tomography angiography and cardiac catheterization. Subsequently, transcatheter closure was performed successfully using a new type of ventricular septal defect occluder from the aortic side. The cardiac murmur disappeared after the intervention, and echocardiography did not reveal any abnormal flow inside the right atrium. At 6 months, the patient had no murmur, and no residual shunt was found using the echocardiogram. Conclusion: Descending aorta-right atrial tunnel is a rare anomaly. Transcatheter closure was successful in our case. Long-term follow-up is needed to assess any progressive growth of the residual tunnel.

Keywords: computed tomography angiography; congenital descending aorta-right atrial tunnel; congenital heart defects; transcatheter closure; ventricular septal defect occluder.

Figure 1

(A) subcostal 2-chamber view: Abnormal color flow was observed at the junction of the superior vena cava and the right atrium, showing a continuous spectrum(arrow). RA, right atrium; LA, left atrium; SVC, superior vena cava. (B) subcostal 2-chamber view postoperative: Abnormal color flow was disappeared at the junction of the superior vena cava and the right atrium.

Figure 2

(A) CTA: An abnormal blood vessel developed from descending aorta, and zigzagged to the right atrium. (B) Cardiac catheterization: An abnormal blood vessel developed from descending aorta, and zigzagged to the right atrium. (C) A VSD occluder has been placed at the inlet of tunnel, there was no obvious shunt revealed by aortography after closure. DAO, descending aorta; RA, right atrium; VSD occluder, ventricular septal defect occluder.