Objective: This study aims to compare the diagnostic accuracy of combined two-dimensional (2D) and real time three-dimensional (RT3D) transesophageal echocardiogram (TEE) imaging with the anatomic findings during surgery in adults with aorto-left ventricular tunnel (ALVT).
Background: ALVT has typically been reported in infants rather than in adults. TEE appears to be a promising method of recognizing the spatial relationship of intracardiac structures.
Methods: Patients underwent comprehensive 2D and RT3DTEE within 1 week preoperative and intraoperative. The TEE images were compared with the surgical findings.
Results: Nine patients diagnosed with ALVT using TEE were selected. The operations were successfully performed in 8 patients. The origin of the tunnels diagnosed by TEE was superior to the right coronary sinus (RCS) in 3 patients, superior to the commissure of the left coronary sinus (LCS) and the RCS in 3 patients, inferior to the junction of the LCS and noncoronary sinus (NCS) in 2 patients, and superior to the NCS in 1 patient. The surgical findings confirmed ALVT in 8 patients. The average diameter of the tunnel orifices in the LV or in the aorta measured by TEE versus surgery was 6.15 ± 3.21 mm versus 6.80 ± 3.91 mm (correlation displayed as r = 0.99, P < 0.0001). Seven (78%) patients had mild to severe aortic regurgitation, and 6 (67%) patients had mitral regurgitation.
Conclusions: A combination of 2D and RT3DTEE imaging modalities would be needed to optimally define the anatomy and functional consequences of ALVT in adults.
Keywords: adults; aorto-left ventricular tunnel; real time three-dimensional; transesophageal echocardiography; two-dimensional.
© 2015, Wiley Periodicals, Inc.