Aortico-left ventricular tunnel with ventricular septal defect: Two-dimensional/doppler echocardiographic diagnosis

Abstract

Aortico-left ventricular tunnel is a rare congenital anomaly that presents as aortic regurgitation and congestive heart failure in childhood. Its association with a ventricular septal defect is even more rare. Because of the distortion of the normal anatomy around the aortic valve and the rarity of this combination of defects, the diagnosis of aortico-left ventricular tunnel with ventricular septal defect may be difficult. The two-dimensional and Doppler echocardiographic findings of aortico-left ventricular tunnel are described.

Aortico-left ventricular tunnel associated with critical aortic stenosis in the newborn

“…The two-dimensional and Doppler echocardiographic appearances of aortico-left ventricular tunnel have been reported previously in a small number of patients [1,4,6,9,12], and one report has documented the color flow appearances of this lesion [6]. Despite certain atypical features of our case, the major echocardiographic findings are similar to those previously described, including the apparent ventricular septal drop out on long-axis parasternal imaging [4,9,12] and difficulty with adequate visualization and measurement of the aortic orifice of the tunnel [12].…”

“…Angiography had been performed in all reported cases and the angiographic features of this lesion have been well reviewed [3], and may be misleading [1,6,12]. Humes et al [6] have suggested that echocardiography might be superior to angiography in the diagnosis of aortico-left ventricular tunnel and that cardiac catheterization may be unnecessary.…”

Clinical value of diagnosing aortico-left ventricular tunnel by echocardiography

“…Echocardiography can clearly show ALVT in two-dimensional images in real time, and CDFI can display the blood flow signal within ALVT. Echocardiography is non-invasive, accurate, and simple to use and has become the standard imaging exam for diagnosing ALVT (22–24). Of the 153 cases reported, the accuracy rate of the ultrasound diagnosis was 79.7%, the misdiagnosis rate was 17.0%, and missed diagnosis rate was 3.3%.…”

Transesophageal Echocardiography for the Evaluation of Aorto‐Left Ventricular Tunnel in Adults, with Follow‐ups

“…[17][18][19] Some reports supported that patients with type I ALVT do not require surgical treatment. After severe progressive valvular insufficiency or endocarditis occurs, congenital aortic wall weakness and fragile aortic annular tissue will be less likely to support prosthetic valve replacement.…”

“…Therefore, severe paravalvular leakage may be a complication, just as in case 1 in this study. 18,[23][24][25] Limitations: This single-center study included an extremely small number of study patients. [17][18][19] Some reports supported that patients with type I ALVT do not require surgical treatment.…”