Surgical Repair of Aortoventricular Tunnel Connected to the Apex of the Right Ventricle in a Neonate Dmitry Bobylev, MD, Masamichi Ono, MD, PhD, Anneke.

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Surgical Repair of Aortoventricular Tunnel Connected to the Apex of the Right Ventricle in a Neonate Dmitry Bobylev, MD, Masamichi Ono, MD, PhD, Anneke Neumann, MD, Harald Bertram, MD, Alexander Horke, MD The Annals of Thoracic Surgery Volume 97, Issue 4, Pages 1433-1436 (April 2014) DOI: 10.1016/j.athoracsur.2013.06.121 Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Preoperative image from 2-dimensional echocardiogram. Parasternal short-axis view with color Doppler demonstrating a tunnel-like structure originating from the aorta with turbulent jet. (Ao = aorta; LA = left atrium; PA = pulmonary artery; * = tunnel.) The Annals of Thoracic Surgery 2014 97, 1433-1436DOI: (10.1016/j.athoracsur.2013.06.121) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Still images of angiographic procedure. (A) Retrograde aortography is performed with selected contrast injection into (B) right coronary artery and into (C, D) tunnel. White arrow shows an aneurysmal communication between the aorta and right ventricle. (Ao = aorta; RCA = right coronary artery; RV = right ventricle.) The Annals of Thoracic Surgery 2014 97, 1433-1436DOI: (10.1016/j.athoracsur.2013.06.121) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Intraoperative photographs as seen from the surgeon's view. (A) After establishment of cardiopulmonary bypass, heart was rotated and tunnel was identified. (B) Left coronary sinus had multiple fenestrations. Tunnel was opened. (C) White arrow shows coronary guide, which was introduced through the entrance of the tunnel in the left coronary sinus. (D) Closure of proximal and distal parts of tunnel with polytetrafluoroethylene patches. (Ao = aorta; PA = pulmonary artery; RV = right ventricle; *= tunnel.) The Annals of Thoracic Surgery 2014 97, 1433-1436DOI: (10.1016/j.athoracsur.2013.06.121) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions