Total eclipse in the heart

Netherlands Heart Journal, Dec 2017

R. J. de Winter

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Total eclipse in the heart

Netherlands Heart Journal January 2018, Volume 26, Issue 1, pp 52–52 | Cite as Total eclipse in the heart AuthorsAuthors and affiliations R. J. de Winter Open Access Image Puzzle - Answer First Online: 14 December 2017 1 Shares 253 Downloads Answer Aorto-right atrial tunnel (ARAT) 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. References 1. 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.CrossRefPubMedPubMedCentralGoogle Scholar Copyright information © The Author(s) 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Authors and Affiliations R. J. de Winter1Email author1.Department of CardiologyAcademic Medical CenterAmsterdamThe Netherlands

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R. J. de Winter. Total eclipse in the heart, Netherlands Heart Journal, 2017, 52-52, DOI: 10.1007/s12471-017-1059-z