{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:49:59Z","timestamp":1753876199735,"version":"3.41.2"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>An aorta-right atrial tunnel (ARAT) is a rare congenital cardiac anomaly that connects the aorta at any coronary sinus to the right atrium. Its cause remains unclear and may involve abnormal origins of the coronary arteries. There is no established link between ARAT and mitral valve prolapse (MVP). Diagnosing ARAT can be challenging, often necessitating multiple imaging techniques, while its management is complex and is further complicated by the association with MVP in our patient.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>We report a case of a 46-year-old man admitted for dyspnoea and palpitations. Thirteen years prior, he had been diagnosed with a cardiac murmur. Echocardiography revealed ARAT and MVP complicated by a flail leaflet and severe regurgitation. AngioCT confirmed the right coronary sinus as the origin of the ARAT and demonstrated the right coronary artery (RCA) arising deep within the tunnel. Cardiac catheterisation identified unclassified pulmonary hypertension due to a left-to-right shunt, along with severe mitral regurgitation. Given the unfavourable anatomy for interventional treatment and the patient's decline in surgery despite multiple consultations, our team opted for conservative management. Currently, the patient\u2019s clinical status and echocardiographic parameters remain stable.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>ARAT is a complex congenital disorder that presents diagnostic and treatment challenges, requiring multimodal imaging and teamwork. Since the RCA originates deep within the tunnel and is associated with MVP complicated by flail leaflet and severe regurgitation, we recommend surgical intervention as the appropriate treatment approach. Considering the patient\u2019s preferences, conservative treatment was chosen.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaf147","type":"journal-article","created":{"date-parts":[[2025,3,30]],"date-time":"2025-03-30T20:35:29Z","timestamp":1743366929000},"source":"Crossref","is-referenced-by-count":0,"title":["Aorta-right atrium tunnel and mitral valve prolapse complicated with flail leaflet: a case report of a multimodality approach for an accurate diagnosis"],"prefix":"10.1093","volume":"9","author":[{"given":"Andreea","family":"Varvara","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Medicine and Pharmacy \u2018Carol Davila,\u2019 Eroii Sanitari Bvd., No. 8, Sector 5, Bucharest 020021 ,","place":["Romania"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruxandra Oana","family":"Jurcu\u021b","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Medicine and Pharmacy \u2018Carol Davila,\u2019 Eroii Sanitari Bvd., No. 8, Sector 5, Bucharest 020021 ,","place":["Romania"]},{"name":"Department of Cardiology, Emergency Institute for Cardiovascular Diseases \u2018Prof. Dr. C.C. Iliescu,\u2019 Sos. Fundeni, No. 258, Sector 2, Bucharest 022322 ,","place":["Romania"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucian","family":"Predescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Medicine and Pharmacy \u2018Carol Davila,\u2019 Eroii Sanitari Bvd., No. 8, Sector 5, Bucharest 020021 ,","place":["Romania"]},{"name":"Department of Cardiology, Emergency Institute for Cardiovascular Diseases \u2018Prof. Dr. C.C. Iliescu,\u2019 Sos. Fundeni, No. 258, Sector 2, Bucharest 022322 ,","place":["Romania"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ioana","family":"Lupescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Medicine and Pharmacy \u2018Carol Davila,\u2019 Eroii Sanitari Bvd., No. 8, Sector 5, Bucharest 020021 ,","place":["Romania"]},{"name":"Department of Radiology, Fundeni Clinical Institute , Sos. Fundeni, No. 258, Sector 2, Bucharest 022328 ,","place":["Romania"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4429-5818","authenticated-orcid":false,"given":"Daniela Oana","family":"Andrei","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Emergency Institute for Cardiovascular Diseases \u2018Prof. Dr. C.C. Iliescu,\u2019 Sos. Fundeni, No. 258, Sector 2, Bucharest 022322 ,","place":["Romania"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,3,28]]},"reference":[{"key":"2025041510385290100_ytaf147-B1","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/S0022-5223(19)37702-5","article-title":"Aorta-right atrial communication. Report of an unusual case","volume":"80","author":"Coto","year":"1980","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025041510385290100_ytaf147-B2","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1016\/S0022-5223(19)35961-6","article-title":"Congenital aortic-right atrial communications: the dilemma of differentiation from coronary-cameral fistula","volume":"91","author":"Rosenberg","year":"1986","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025041510385290100_ytaf147-B3","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1016\/j.jtcvs.2005.07.021","article-title":"Aorta-right atrial tunnel: clinical presentation, diagnostic criteria, and surgical options","volume":"130","author":"Gajjar","year":"2005","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025041510385290100_ytaf147-B4","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1007\/s00246-021-02671-5","article-title":"Congenital aorto-cardiac connections (CACC) revisited: introduction of a novel anatomic-therapeutic classification","volume":"42","author":"Rad","year":"2021","journal-title":"Pediatr Cardiol"},{"key":"2025041510385290100_ytaf147-B5","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1136\/hrt.41.1.28","article-title":"Location and vascular supply of sinus node in human heart","volume":"41","author":"Anderson","year":"1979","journal-title":"Br Heart J"},{"key":"2025041510385290100_ytaf147-B6","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1378\/chest.63.2.198","article-title":"Aortico right ventricular tunnel","volume":"63","author":"Bharati","year":"1973","journal-title":"Chest"},{"key":"2025041510385290100_ytaf147-B7","doi-asserted-by":"crossref","first-page":"1077788","DOI":"10.3389\/fcvm.2023.1077788","article-title":"Genetics and pathophysiology of mitral valve prolapse","volume":"10","author":"Delwarde","year":"2023","journal-title":"Front Cardiovasc Med"},{"key":"2025041510385290100_ytaf147-B8","doi-asserted-by":"crossref","first-page":"e454","DOI":"10.1161\/CIRCULATIONAHA.115.020161","article-title":"Aorta\u2013right atrial tunnel","volume":"133","author":"Lee","year":"2016","journal-title":"Circulation"},{"key":"2025041510385290100_ytaf147-B9","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/j.ijcard.2005.01.056","article-title":"Aorta-right atrial tunnel\u2014a novel therapeutic option [1]","volume":"107","author":"Sreedharan","year":"2006","journal-title":"Int J Cardiol"},{"key":"2025041510385290100_ytaf147-B10","doi-asserted-by":"crossref","first-page":"24","DOI":"10.7196\/AJTCCM.2023.v29i1.270","article-title":"A rare case of aorta-right atrial tunnel demonstrated on coronary computed tomography angiography","volume":"11","author":"Kalekar","year":"2023","journal-title":"Afr J Thorac Crit Care Med"},{"key":"2025041510385290100_ytaf147-B11","first-page":"1","article-title":"Infective endocarditis of an asymptomatic congenital aorta-right atrial tunnel: a case report","volume":"4","author":"Onorato","year":"2021","journal-title":"Eur Heart J Case Rep"},{"key":"2025041510385290100_ytaf147-B12","first-page":"480","article-title":"Aorta-right atrial tunnel","volume":"37","author":"Sai Krishna","year":"2010","journal-title":"Tex Heart Inst J"},{"author":"Jain","key":"2025041510385290100_ytaf147-B13"},{"key":"2025041510385290100_ytaf147-B14","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1093\/ejechocard\/jeq031","article-title":"European association of echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease)","volume":"11","author":"Lancellotti","year":"2010","journal-title":"Eur J Echocardiogr"},{"key":"2025041510385290100_ytaf147-B15","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS guidelines for the management of valvular heart disease","volume":"43","author":"Vahanian","year":"2022","journal-title":"Eur Heart J"},{"key":"2025041510385290100_ytaf147-B16","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.jtcvs.2019.01.023","article-title":"Transcatheter or surgical repair for degenerative mitral regurgitation in elderly patients: a propensity-weighted analysis","volume":"158","author":"Buzzatti","year":"2019","journal-title":"J Thorac Cardiovasc Surg"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/9\/4\/ytaf147\/62788826\/ytaf147.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/9\/4\/ytaf147\/62788826\/ytaf147.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T10:39:14Z","timestamp":1744713554000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytaf147\/8098563"}},"subtitle":[],"editor":[{"given":"Flemming Javier","family":"Olsen","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Rizwan","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Melonie","family":"Johns","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Abdullah","family":"Abdullah","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,3,28]]},"references-count":16,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,3,28]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytaf147","relation":{},"ISSN":["2514-2119"],"issn-type":[{"type":"electronic","value":"2514-2119"}],"subject":[],"published-other":{"date-parts":[[2025,4]]},"published":{"date-parts":[[2025,3,28]]},"article-number":"ytaf147"}}