J Thorac Cardiovasc Surg. 2011 Dec 9;
da Silva JP, da Fonseca da Silva L, Lopes LM, Moreira LF, Caneo LF, Franchi SM, Lianza AC, Baumgratz JF, Duarte Flavio Magalhaes J

OBJECTIVE: Optimal surgical treatment of patients with transposition of the great arteries (TGA), ventricular septal defect (VSD), and pulmonary stenosis (PS) remains a matter of debate. This study evaluated the clinical outcome and right ventricle outflow tract performance in the long-term follow-up of patients subjected to pulmonary root translocation (PRT) as part of their surgical repair. METHODS: From April 1994 to December 2010, we operated on 44 consecutive patients (median age, 11 months). All had malposition of the great arteries as follows: TGA with VSD and PS (n = 33); double-outlet right ventricle with subpulmonary VSD (n = 7); double-outlet right ventricle with atrioventricular septal defect (n = 1); and congenitally corrected TGA with VSD and PS (n = 3). The surgical technique consisted of PRT from the left ventricle to the right ventricle after construction of an intraventricular tunnel that diverted blood flow from the left ventricle to the aorta. RESULTS: The mean follow-up time was 72 ± 52.1 months. There were 3 (6.8%) early deaths and 1 (2.3%) late death. Kaplan-Meier survival was 92.8% and reintervention-free survival was 82.9% at 12 years. Repeat echocardiographic data showed nonlinear growth of the pulmonary root and good performance of the valve at 10 years. Only 4 patients required reinterventions owing to right ventricular outflow tract problems. CONCLUSIONS: PRT is a good surgical alternative for treatment of patients with TGA complexes, VSD, and PS, with acceptable operative risk, high long-term survivals, and few reinterventions. Most patients had adequate pulmonary root growth and performance.

J Card Surg. 2011 Sep; 26(5): 521-6
Talwar S, Nair VV, Kothari SS, Gulati GS, Choudhary SK, Airan B

Two patients with aortic right ventricular tunnel and anomalous origin of the right coronary artery from the tunnel are reported. The literature on this condition is reviewed. 

J Card Surg. 2011 Jul; 26(4): 437-9
Colak N, Nazli Y, Alpay MF, Cakir O

Aorto-ventricular tunnel is a rare congenital anomaly, an abnormal paravalvular communication between the aorta and the left ventricle. We report successful surgical correction in a patient with aorto-left ventricular tunnel associated with a single coronary artery and aortic insufficiency who had undergone surgical correction a year before. 

Neurology. 2011 Jun 14; 76(24): 2129
Wollenweber FA, Brehmer K, Mühler E, Werner CJ, Hoffmann R, Schulz JB, Reich A

Thorac Cardiovasc Surg. 2011 Aug; 59(5): 293-7
Valeske K, Huber C, Mueller M, Böning A, Hijjeh N, Schranz D, Akintuerk H

The term "subaortic stenosis" includes a variety of obstructions of the left ventricular outflow tract (LVOT), ranging from a short (discrete) subvalvular membrane to long, tunnel-like narrowing. An association with other congenital lesions is frequent. We reviewed the reported literature and describe our results, analyzing the nomenclature of and risk factors for restenosis after surgical treatment.From 1994 to 2009, 81 children (53 males, 28 females; median age: 57 months, range [ R]: 5-204) underwent surgical relief of a subaortic stenosis. Patients were divided, according to pathology, into short segment (group A, n = 42) and complex obstructions (group B, n = 39), with the latter including long segment stenosis and/or associated anomalies such as aortic coarctation, interrupted aortic arch or Shone's complex.Surgery resulted in a significant reduction of the gradient between the left ventricle and the aorta in both groups (Δ P group A: 51 ± 28 mmHg, group B: 46 ± 25 mmHg). There was no operative mortality. One patient died in the early postoperative period due to pericardial tamponade. Median follow-up was 90 months (R = 0.5-187). Twenty-five (31%) patients required reoperation because of recurrent stenosis after a median of 43 months (R = 0.5-128). Seven (16%) patients belonging to group A developed restenosis, and 18 (46%) in group B. Freedom from reoperation for all patients was 60% after 10 years. 10 (40%) of the patients of group B were ultimately treated with a Ross-Konno reconstruction of the LVOT.Despite adequate surgical resection, recurrence of subaortic stenosis within several years after initial surgical treatment is frequent, especially in patients with complex lesions. In cases requiring reoperation, the surgical therapy is often extensive, and even includes Ross-Konno reconstruction of the LVOT.

Pediatr Cardiol. 2011 Aug; 32(6): 822-5
Singh A, Reinhardt Z, Desai T, Rasiah SV

J Cardiovasc Dis Res. 2010 Oct; 1(4): 206-9
Saritas T, Erol N, Erdem A, Karaci A, Celebi A

Aortico-left ventricular tunnel is extremely rare congenital paravalvar communication between the aorta and the left ventricle. Usually it is treated surgically. In addition to the surgery the tunnel can be closed by percutaneous transcatheter intervention in appropriate patients. We present in this paper 7 months, 10 years, and 1,5 months old three male cases with aortico-left ventricular tunnel that were surgically treated and followed up within 7 years in our clinic.

Ann Thorac Surg. 2011 Feb; 91(2): e23-5
Kaiser CA, Chung T, Rosenfeld HM, Reinhartz O

Aortico-left ventricle tunnels are rare congenital anomalies with variable anatomy; however, by definition, they consist of an abnormal connection between the ascending aorta and the left ventricle. Diagnosis is usually by echocardiography, and treatment typically uses a two-patch surgical repair. Herein, we describe a case of an aortico-left ventricle tunnel, with the tunnel bifurcating before entering the left ventricle. Preoperative echocardiography and magnetic resonance imaging show the lesion in great detail. Two patches were required on the left-ventricular side of the tunnel for closure. A bifurcating aortico-left ventricle tunnel has not yet been described in the literature. The preoperative imaging and surgical management are discussed.

J Invasive Cardiol. 2010 Dec; 22(12): 611-4
Poptani VA, Thakkar BM, Patel NH

Cardiol Young. 2010 Dec; 20 Suppl 3: 92-9
Anderson RH, Cook A, Brown NA, Henderson DJ, Chaudhry B, Mohun T

Although malformations involving the ventricular outflow tracts are often described as conotruncal malformations, there is no consensus as to the lesions included in, or excluded from, this category, reflecting, in part, the current lack of precise definitions of the embryonic truncus and conus. Analysis of development of the outflow tract in terms of proximal, intermediate, and distal components greatly facilitates understanding of the morphology of the aortopulmonary window and aortoventricular tunnels. The aortopulmonary windows reflect failure to close the embryonic aortopulmonary foramen, the space between the distal end of the cushions that divide the lumen of the outflow tract itself and the dorsal wall of the aortic sac. The aortopulmonary tunnels are produced subsequent to abnormal development of the cushions themselves. The distal ends of these cushions excavate to produce the sinuses and leaflets of the arterial valves. The proximal parts of the cushions muscularise to form the subpulmonary infundibulum. The middle part of the cushion mass disappears to provide a tissue plane between the infundibulum and the aortic root. Abnormal formation of this area accounts for the various types of aortoventricular tunnel. In our brief review, we show how the anatomy of these lesions correlates with development of the outflow tract.

J Am Coll Cardiol. 2010 Aug 3; 56(6): e11
Bratsas A, Vlachopoulos C, Kotoulas G, Makris T, Stefanadis C

Ann Thorac Surg. 2010 Jun; 89(6): 2024-6
Lin BS, Zhang XH, Jiang YZ, Zhang BM, Gao D, Song J

Aortico-right ventricular tunnel (ARVT) was successfully corrected in a 32-year-old patient. The diagnosis was preoperatively suspected on the basis of Doppler echocardiography and it was confirmed by a three-dimensional computed tomographic scan. The ARVT originated independently above the right coronary sinus. Surgical closure with 5-0 polypropylene in the middle of the tunnel under modest hypothermia was successfully performed. Follow-up was found to be satisfactory 3 months later.