Multi-modality imaging in congenital aorto-right atrial tunnel

A 38-year-old woman presented with paroxysmal atrial fibrillation. Echocardiography ( Panel A ; see Supplementary data online, Movies S1 and S2 ) revealed a prominent left sinus of Valsalva with tortuous tubular structure seen superior to the atria adjacent to the intra-atrial septum and emptying into the superior aspect of the right atrium (RA). Computed tomography (CT) coronary angiogram ( Panels B – D ) and cardiac magnetic resonance (CMR) imaging ( Panels E – G ; see Supplementary data online, Movie S3 ) confirmed a tortuous, tubular structure arising from the left sinus of Valsalva taking a retroaortic course running adjacent to the RA aspect of the inter-atrial septum …