Surgical Resolution of an Aorto-Atrial Tunnel

BACKGROUND: Aorto-right atrial tunnel (ARAT) is an exceptionally rare congenital extracardiac communication between the aorta and right atrium, often presenting with symptoms of volume overload and heart failure. CASE SUMMARY: A 40-year-old woman with a known diagnosis of ARAT for 18 years presented with worsening palpitations and exertional dyspnea. Cardiac computed tomography revealed a tubular tract originating from the right coronary cusp and draining into the right atrium. Surgical repair under cardiopulmonary bypass was performed with closure of the aortic and atrial openings while preserving the right coronary artery. Postoperatively, she had a smooth recovery. DISCUSSION: This case highlights the diagnostic challenge of differentiating ARAT from coronary fistula or sinus of Valsalva rupture. Surgical resolution remains the definitive therapy. TAKE-HOME MESSAGE: Early identification and surgical management of ARAT prevent long-term complications and lead to complete symptom resolution.