Surgical Resolution of an Aorto-Atrial Tunnel

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Aorto-right atrial tunnel (ARAT) (n=1). Intervention: Surgical repair under cardiopulmonary bypass. Primary outcome: Complete symptom resolution and absence of residual shunt.

Q: What does this research mean for the field?

Surgical repair of an aorto-right atrial tunnel achieves complete symptom resolution, eliminates residual left-to-right shunting, and preserves ventricular function. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Khuzaima Tariq; Maria Arain; Shakir Ullah

doi:10.1016/j.jaccas.2026.107720

March 1, 2026JACC Case ReportsOpen Access

Surgical Resolution of an Aorto-Atrial Tunnel

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Key result

Surgical repair of an aorto-right atrial tunnel yields complete symptom resolution without residual shunt.

n=1

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Why the study?

Aorto-right atrial tunnel is an exceptionally rare congenital extracardiac communication often presenting with volume overload and heart failure symptoms, requiring definitive surgical therapy.

Key Points

To describe the clinical presentation, anatomical evaluation, and surgical correction of a rare congenital aorto-right atrial tunnel.
Evaluated a 40-year-old woman with worsening palpitations, exertional dyspnea, and an 18-year history of aorto-right atrial tunnel using echocardiography, cardiac computed tomography, and angiography.
Established cardiopulmonary bypass via median sternotomy and bicaval cannulation, delivering cardioplegia while temporarily occluding the fistulous tract.
Divided the tunnel distal to the right coronary artery origin, closed the proximal aortic opening using 5-0 monofilament running suture, and patched the distal right atrial opening with autologous pericardium.
Preoperative computed tomography revealed a 13-mm tubular tract from the right coronary cusp enlarging into a 2.5 × 3 cm sac before draining into the right atrium, with an ejection fraction of 30%.
Surgical repair achieved complete closure of the aortic and right atrial openings while preserving the separate origins of the right coronary artery and conus branch located within the tunnel.
Postoperative recovery was uneventful, with complete absence of residual shunt and satisfactory biventricular function documented at 1-month follow-up.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 female patient (age 40) with an 18-year history of aorto-right atrial tunnel and reduced ejection fraction (30%), followed for 1 month postoperatively.

I

Intervention

Surgical repair under cardiopulmonary bypass via median sternotomy, involving division of the fistulous tunnel distal to the right coronary artery (RCA) origin, proximal closure with a 5-0 monofilament running suture, and closure of the distal opening into the right atrium with an autologous pericardial patch while preserving the RCA.

O

Outcome

Symptom resolution and echocardiographic assessment of residual shunt and biventricular function at 1-month follow-up

Surgical closure of a rare congenital aorto-right atrial tunnel involving the right coronary artery origin successfully resolved heart failure symptoms and eliminated the shunt while preserving native coronary perfusion.

Limitations

Single-patient case report
Short follow-up duration of 1 month

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Implication

Supports surgical closure for symptomatic aorto-right atrial tunnel; hypothesis-generating given single-case evidence and short follow-up.

Abstract

BACKGROUND: Aorto-right atrial tunnel (ARAT) is an exceptionally rare congenital extracardiac communication between the aorta and right atrium, often presenting with symptoms of volume overload and heart failure. CASE SUMMARY: A 40-year-old woman with a known diagnosis of ARAT for 18 years presented with worsening palpitations and exertional dyspnea. Cardiac computed tomography revealed a tubular tract originating from the right coronary cusp and draining into the right atrium. Surgical repair under cardiopulmonary bypass was performed with closure of the aortic and atrial openings while preserving the right coronary artery. Postoperatively, she had a smooth recovery. DISCUSSION: This case highlights the diagnostic challenge of differentiating ARAT from coronary fistula or sinus of Valsalva rupture. Surgical resolution remains the definitive therapy. TAKE-HOME MESSAGE: Early identification and surgical management of ARAT prevent long-term complications and lead to complete symptom resolution.

Discussion

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Cite This Study

Tariq et al. (2026) conducted a case report in Aorto-right atrial tunnel (ARAT) (n=1). Surgical repair under cardiopulmonary bypass was evaluated on Complete symptom resolution and absence of residual shunt. Surgical repair of an aorto-right atrial tunnel in a 40-year-old woman resulted in complete symptom resolution, no residual shunt, and satisfactory biventricular function at 1-month follow-up.

synapsesocial.com/papers/69cb64b0e6a8c024954b8af3 https://doi.org/10.1016/j.jaccas.2026.107720

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Surgical Resolution of an Aorto-Atrial Tunnel

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Surgical Resolution of an Aorto-Atrial Tunnel

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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