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The entrance of the tunnel arises from one of the coronary cusps of the aorta. Because this structure may arise from the non-coronary cusp, this is not considered to be a coronary fistula [ 1]. The tunnel connects with the right atrium. Closing the ARAT with vascular plugs is achieved as follows: The entrance of the tunnel is visualised from the aorta. A wire is passed down and snared in the right atrium or superior caval vein and a body loop is formed. Careful positioning of a delivery sheath from the venous side into the tunnel is performed, without traction on the entrance of the tunnel or the aorta. Large size vascular plugs are often needed.
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go back to reference de Winter RJ, Blom NA, Straver B, et al. Two cases of aorto-right atrial tunnel: clinical presentation, imaging and percutaneous closure. Neth Heart J. 2012;20:509–12. CrossRefPubMedPubMedCentral de Winter RJ, Blom NA, Straver B, et al. Two cases of aorto-right atrial tunnel: clinical presentation, imaging and percutaneous closure. Neth Heart J. 2012;20:509–12. CrossRefPubMedPubMedCentral
- Total eclipse in the heart
R. J. de Winter
- Bohn Stafleu van Loghum