Aorta-Right Atrium Tunnels: A Heart-Blowing Diagnosis

Abstract

This case report presents the diagnostic pathway and management of a rare congenital cardiac anomaly with an aorto-right atrial communication. Case: A 20-year-old male was assessed in clinic due to chest pain with aortic dilation. He presented acutely with recurrent chest pain. He underwent multimodality cross-sectional imaging and invasive testing to determine the anatomical and physiological nature of the defect. Given the recurrent chest pain and known dilated aorta, the patient first underwent cardiac computed tomography, which incidentally detected the anatomical defect. A communication from the aortic sinuses to the right atrium was identified, which was previously unknown. Further assessment with cardiac magnetic resonance imaging did not demonstrate a significant shunt with a QpQs of 1:1. He proceeded to invasive catheter, which further defined the anatomical course of the communication, and haemodynamic data further supported the absence of a significant shunt. Consensus from the Adult Congenital Group was to pursue conservative management. Aorta-right atrium tunnels continue to be a rare entity. Multimodality imaging is crucial in defining the anatomical and physiological parameters of the congenital lesion, allowing for improved clinical decision-making. In this case, unlike previous common practice when most of these patients received surgery regardless of their haemodynamic situation, the patient was conservatively managed. With combining clinical and advanced imaging, this shift away from interventions is becoming more common.