Aortico-Left Ventricular Tunnel: Diagnosis Based on Two-Dimensional Echocardiography, Color Flow Doppler Imaging, and Magnetic Resonance Imaging RICHARD.

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Presentation transcript:

Aortico-Left Ventricular Tunnel: Diagnosis Based on Two-Dimensional Echocardiography, Color Flow Doppler Imaging, and Magnetic Resonance Imaging RICHARD A. HUMES, M.D. Mayo Clinic Proceedings Volume 61, Issue 11, Pages 901-907 (November 1986) DOI: 10.1016/S0025-6196(12)62613-5 Copyright © 1986 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 1 Lateral view angiocardiogram after injection of contrast medium into left ventricle (LV), demonstrating dilated aortic root and anterior aortico-left ventricular tunnel (arrowheads). Mayo Clinic Proceedings 1986 61, 901-907DOI: (10.1016/S0025-6196(12)62613-5) Copyright © 1986 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 2 Two-dimensional echocardiograms from parasternal short and long axes. A, Short-axis scan below level of aortic valve shows outpouching of left ventricular outflow tract (arrowheads). B, Short-axis scan at level of aortic valve (AV) shows large aneurysmal dilatation of aortico-left ventricular tunnel (arrowheads). Left coronary artery is clearly identified (black arrow). C, Short-axis scan above aortic valve demonstrates clear communication with tunnel (arrowheads) and aorta (white arrows). Both coronary arteries are clearly evident (black arrows). D, Long-axis scan during systole shows entry of tunnel into left ventricle (LV) below aortic valve (large arrow). Aneurysmal dilatation of tunnel is evident anterior to aortic valve (arrowheads). Thickening and doming of aortic valve suggest aortic stenosis (small arrows). E, Long-axis view of ascending aorta demonstrates tunnel entry into left ventricle (large arrow) and extent of tunnel (small arrowheads) along dilated ascending aorta (large arrowheads). A = anterior; Ao = aorta; L = left; LA = left atrium; MV = mitral valve; RA = right atrium; RV = right ventricle; S = superior; TV = tricuspid valve; VS = ventricular septum. Mayo Clinic Proceedings 1986 61, 901-907DOI: (10.1016/S0025-6196(12)62613-5) Copyright © 1986 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 3 Color flow Doppler imaging from parasternal long axis. A, Image during early diastole shows inflow (orange) through mitral valve (large arrowhead). Regurgitation into left ventricle through tunnel (arrow) is depicted as speckled yellow and blue, indicating turbulent high-velocity flow. B, Corresponding two-dimensional still frame depicts tunnel (arrow). C, View during late diastole shows continued regurgitation through tunnel (arrow) into left ventricle. D and E, Systolic and diastolic frames show orange forward flow (large arrowhead) through tunnel during systole (SYS) and speckled, turbulent, regurgitant flow (arrow) during diastole (DIAS). For explanation of abbreviations, see legend for Figure 2. Mayo Clinic Proceedings 1986 61, 901-907DOI: (10.1016/S0025-6196(12)62613-5) Copyright © 1986 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 4 Coronal, sagittal, and transverse magnetic resonance images. A, Coronal section through left ventricular outflow tract. B, Coronal section anterior to A demonstrates tunnel (arrowheads). C, Sagittal section through aorta shows relationship of tunnel (arrow) to posterior structures. D, Transverse section above aortic valve demonstrates tunnel (arrowheads) and relationship to aorta. E, Transverse section cephalad to D demonstrates relationship of tunnel (arrowheads) to aorta and main pulmonary artery. A = anterior; AO = aorta; L = left; LPA, MPA, and RPA = left, main, and right pulmonary artery, respectively; LV = left ventricle; RV = right ventricle; S = superior. Mayo Clinic Proceedings 1986 61, 901-907DOI: (10.1016/S0025-6196(12)62613-5) Copyright © 1986 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 5 View of heart at time of surgical procedure, demonstrating dilated tunnel (arrowheads) and its relationship to surrounding structures, including right atrium (RA) and right coronary artery (RCA). L = left; S = superior. Mayo Clinic Proceedings 1986 61, 901-907DOI: (10.1016/S0025-6196(12)62613-5) Copyright © 1986 Mayo Foundation for Medical Education and Research Terms and Conditions