Clinical value of diagnosing aortico-left ventricular tunnel by echocardiography

Abstract

In order to assess the clinical value of echocardiography in the diagnosis of aortico-left ventricular tunnel (ALVT) the echocardiographic data and clinical manifestations of six patients with ALVT were analyzed in the present study. Based on the results, a comprehensive study was conducted regarding 147 cases from related documents. Six patients were confirmed with ALVT by surgery. The echocardiographic images of the patients revealed an abnormal communication beginning in the ascending aorta above the coronary arteries, bypassing the aortic valve, and ending in the left ventricle. The color Doppler flow imaging showed a high-speed to- and -fro flow with or without the involvement of the aortic valve. According to Hovaguimian type casting, there were two cases of type I, two cases of type III, one case of type IV, and one case of type II (postoperative recanalization). Of the 153 cases reported, the accuracy rate of the ultrasound diagnosis was 79.6%, the misdiagnosis rate was 17.1%, and the missed diagnostic rate was 3.3%. In conclusion, echocardiography is the preferred method for non-invasive preoperative diagnosis of the ALVT and can accurately describe the type and involvement of the cardiac structure.

A Review of the Surgical Management of Aorto-ventricular Tunnels

“…9,24,64 Most patients with left ventricular tunnels were symptomatic early during postnatal life and underwent correction before the age of six months. 1 –31,35,37 –39,53 …”

Aorto-right ventricular tunnel originating from left coronary sinus: a case report

“…The aortic right ventricular tunnel is the rarest form of pathology in this group. Tunnels and fistulas most frequently are associated with aortic valve and CA abnormalities (45% of cases) (6)(7)(8)(9)(10)(11)(12)(13)(14).…”

“…Aorto-right ventricular tunnel is an extremely rare anomalous communication between aorta and the right ventricular cavity (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). This defect was first reported by K. Hart (1905) and J.…”

“…Edwards (1961), and was given a term by Levi et al as an aorto-ventricular tunnel in 1963 (13). To date, approximately 147 such cases have been reported (11). The cause of this defect is unknown.…”

Aortico-left ventricular tunnel: updated perspectives

“…Thus, a complete differential diagnosis should also be considered based on heart auscultation [14,15] Recent years, it has been highlighted the importance of prenatal image development and advanced knowledge of ALVT placed on early diagnosis. There are some invasive and non-invasive tools for us to diagnose and locate the tunnel if ALVT is suspected [13] and nearly 80% accuracy rate of the ultrasound diagnosis has been reported [16]. The echocardiography is the convenient and cost-effective way compared with other imaging modalities and can be arranged in intrauterine life by fetal echocardiography to detect the lesion reliably after 18 weeks of gestation [17].…”