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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 4, July/August 2017 AFRICA e5
and procedure-related morbidity and mortality associated with
coronary angiography have motivated the search for alternatives
to this invasive procedure.20
In an article published by Goldberg in 1990, CT and magnetic
resonance (MR) were not widely used. It was reported to be
limited by prolonged imaging time, slice thickness, radiation and
cost.4 With the advent of 64-slice CT, cardiac CT has emerged
as a useful diagnostic imaging modality for the assessment
of cardiac anomalies. Imaging time has been cut down and
the slices are thinner, allowing for accurate evaluation of the
coronary arteries. CT angiography is now easily accessible in
addition to it being non-invasive. A basic principle of radiation
protection is to keep radiation exposure, ‘as low as reasonably
achievable’ (ALARA).21
Tossios et al. were the first to image and document aorta–
right atrial tunnel using cardiovascular magnetic resonance
(CMR), which yielded excellent definition of the topographical
anatomy of the tunnel with regard to its origin, course and
termination. CMR angiography was an additional tool used to
demonstrate blood flow and quantify the left-to-right shunt.12
Therefore the combination of CMR and other modalities has
improved the diagnostic precision of aorta–right atrial tunnel
and has also assisted in ruling out other associated lesions, such
as septal defects.12
Prior to 2003, most cases of ruptured sinus of Valsalva
aneurysms were diagnosed using echocardiography and cardiac
catheterisation. Turkay et al. were the first to diagnose right
coronary sinus tunnel to the right atrium using electron-beam
tomography.22 Tossios and Salehi were the first to diagnose
aorta–right atrial tunnel using CMR.12,18 Table 2 shows a
descriptive summary of cases from 2003, diagnosed using
electron-beam tomography, CT angiography and CMR.
Conclusion
Aorta–right atrial tunnel is a rare, congenital cardiac anomaly. The
diagnosis can be improved using multi-modality imaging, and with
the advent of live three-dimensional echocardiography, improved
CT angiography and functional CMR, detailed non-invasive
imaging may be a favourable adjunct to further treatment.
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