Aortico-Left Ventricular Tunnel

Abstract

To be distinguished from aneurysm of an aortic sinus (Valsalva) is the rare condition in which an abnormal channel begins in the ascending aorta (above the right coronary artery), bypasses the aortic valve, and leads through the ventricular septum into the left ventricular cavity. This entity, which has not previously been diagnosed during life, to our knowledge, is herein named aortico-left ventricular tunnel. The cases of three patients (aged 3, 5, and 10 years) with this rare condition are described. The clinical, electrocardiographic, and radiological features were similar in each case and resembled those in aortic valvular insufficiency. The diagnosis may be established clinically through selective aortography. This reveals that the origin of the abnormal communication lies in the anterior wall of the ascending aorta above the levels of the coronary arterial origins. The abnormal communication leads to the left ventricle. The condition is distinguished from aortic sinus aneurysm by its origin above the level of the aortic sinuses. Identical anatomical findings and the presence of abnormal physical findings since infancy in each of the three patients suggest that this peculiar condition is a congenital malformation.

An unusual case of aorta–right atrial tunnel with windsock aneurysm: imaging, diagnosis and treatment

“…Levy stresses the origin of the abnormal tunnel above and separate from the coronary orifice. 10 Bove and Schwartz, however, emphasise the separation of the orifice of the tunnel from the adjacent sinus of Valsalva by a small well-defined fibrous ridge. 11 In our case, the tunnel gave rise to the right main coronary artery.…”

Tratamento cirúrgico do túnel ventrículo esquerdo-aorta

“…Ao-LVT has a congenital etiology [1][2][3], which can be associated with anomalies of the aortic valve and fetal hydrops or not [2]. Depending of the severity of the aortic regurgitation, intrauterine death can occur or the newborn can die within a few hours of birth [2].…”

“…[7] Treatment is basically surgical at any age [1,2,[4][5][6][7] and it is important to avoid distortion of the aortic valve and/or the annulus as well as dilation of the left ventricle, which can in turn cause aortic valve insufficiency and the necessity of reoperation for valve replacement [8]. Regarding the surgical technique, the fistula can be closed by direct suturing through of aortic orifice [6], as demonstrated in this report, or using bovine pericardium patches to close the aortic orifice [5], to occlude the ventricular orifice [4] or to occlude both ventricular and aortic orifices [4].…”

“…The aorta-left ventricle tunnel (Ao-LVT) is considered to be a rare congenital disease [1][2][3], in which there is an abnormal connection between the left ventricle and the aorta, that is, a connection bypassing the aortic valve. Generally, this condition results in severe aortic regurgitation, rapidly evolving to cardiac decompensation and death [l,2].…”

Surgical Repair of an Aortico-Left Ventricular Tunnel with Acute Infective Endocarditis

“…It was described as a channel arises from the right coronary sinus through the right ventricular outflow tract to enter the left ventricle below the aortic valve. Levy and his associates 1) first reported the entity of the ALVT in 3 patients in 1963. The anatomy of these lesions is highly variable, and numerous case reports have been published describing unique anatomic configurations.…”