{'fraction_non_alphanumeric': 0.04069264069264069, 'fraction_numerical': 0.012987012987012988, 'mean_word_length': 4.868020304568528, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Aorto-right ventricular tunnel causing functional tricuspid atresia.

A girl with symmetrical intrauterine growth retardation and a birth weight of 2240 g was delivered at term by primary cesarean section to a 27-year-old primiparous woman. Fetal echocardiography had shown a nearly atretic tricuspid valve. Postnatally, the child stabilized rapidly but showed signs of heart failure with tachypnea and general weakness, as well as cyanosis (transcutaneous oxygen saturation, 85%).

The presence of an aorto–right ventricular (RV) tunnel (ARVT) was confirmed by transthoracic echocardiography, which showed a 5 to 6×15–mm structure extending from the proximal ascending aorta to the outflow tract of the RV, with the left coronary artery originating from the aortic end of the tunnel. The ARVT caused a strong left-to-right shunt during diastole (Figure 1 and Movies I and II in the online-only Data Supplement).



Figure 1. 
Echocardiographic views. A , Apical 4-chamber view. Arrow indicates the minimal tricuspid valve opening during diastole. B , Aorto–right ventricular tunnel (ARVT). C , Diastolic left-to-right shunt through the ARVT (arrow). RA …