Use of an Amplatzer Duct Occluder for Closing an Aortico-Left Ventricular Tunnel in a Case of Noncompaction of the Left Ventricle

Abstract

Aortico-left ventricular tunnel (ALVT) is a very rare congenital anomaly. Noncompaction of the left ventricle or "spongy myocardium" is another rare congenital cardiomyopathy. We report probably the first case in which these two rare anomalies causing pump failure coexisted in a 4-year-old make and the tunnel was successfully treated nonsurgically. Transcatheter closure of ALVT with the Amplatzer duct occluder is feasible and safe in a case of noncompaction of the LV with reduced LV function.

Transvalvular Aortico left ventricular tunnel – A rare congenital cardiac anomaly

“…Non-surgical device closure of the tunnel is an option in cases with suitable anatomy. 8 Larger communications require surgical repair to prevent progressive cardiac failure. Early closure of the tunnel should prevent aortic valve deformity secondary to annular dilatation and should obviate the need for aortic valve replacement.…”

“…Aneurysmal dilatation was noted at its exit site in the LVOT. In the modified PLAX view and short axis view at aortic valve level, a fenestration was noted in the right coronary cusp of aortic valve which formed the aortic end of the tunnel ( 8). No windsock, dilatation or out pouching of the Sinus of Valsalva was noted.…”

Congenital aortico-left ventricular tunnel in fetuses and infants

“…As for treatment, direct closure and patch closure of the tunnel are primarily performed, and spongy myocardium is also performed [12]. ALVT is usually found near the origin of the right coronary artery [13], and it often is accompanied by histological abnormality of the aortic valve and coronary artery anomalies [1].…”

Novel transcatheter closure of internal iliac arteriovenous malformation

“…The PDA occluder is easy to deploy, has good maneuverability and can be retrieved before deployment. Besides its utility in closing patent ductus arteriosus, the PDA occluder had been used successfully for closure of paravalvular leaks [11], the left ventricle to descending aorta conduit [12], aberrant arteries [13], the aortico left ventricle tunnel [14], aortocaval fistula [15], major aortopulmonary collaterals, the aortopulmonary window, ruptured sinus of the valsalva aneurysm, ventricular septal defects, pseudo aneurysm of the main pulmonary artery, persistent left superior vena cava, coronary artery fistula and the subclavian artery to innominate vein fistula. The PDA duct occluder is an effective alternative for vascular plugs, for closure of internal iliac arteriovenous malformation.…”