Congenital aortico-left ventricular tunnel (ALVT) is rare and similar to ruptured sinus of Valsalva aneurysm. There are limited reports describing these rare entities and their associated surgical treatment. Between July 2004 and April 2016, three patients of different ages were diagnosed with aortico-left ventricular tunnel: two in infancy and one in adulthood. Diagnosis was challenging in all three patients. Surgical treatment with patch closure was successful in all three patients. Regardless of the etiology of ALVT, surgical repair via patch closure is the preferred method. Aortico-left ventricular tunnel (ALVT) is a rare anomaly that results in a paravalvular communication between the ascending aorta and the left ventricle (LV) [1-2]. The tunnel bypasses the aortic valve and may lead to aortic insufficiency (AI), cardiomegaly, LV dilatation, and congestive heart failure [1-3]. Surgery remains the best definitive treatment option [2-3]. ALVT is exceedingly rare representing 0.001% of all congenital heart defects [2-3], and
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She had a history of treated methicillin-resistant staphylococcus aureus bacteremia and endocarditis with involvement of the tricuspid valve. On admission, a cardiac computerized tomography angiogram (CTA) failed to demonstrate an aortic root abscess. However, an SVA was seen arising from the inferior right aortic cusp measuring 2.1 x 1.5 cm that descended along the intraventricular septum without communication to the right ventricle. The coronary anatomy was usual and all cardiac chambers were of normal size and thickness. Transthoracic echocardiogram revealed an echo-lucent space anterior to the aortic valve and aortic root, suggestive of a paravalvular abscess, with regurgitant flow into the LVOT and possibly into the lower right atrium (RA) (Fig. 3). The patient’s preoperative LV EF was
She had a history of treated methicillin-resistant staphylococcus aureus bacteremia and endocarditis with involvement of the tricuspid valve. On admission, a cardiac computerized tomography angiogram (CTA) failed to demonstrate an aortic root abscess. However, an SVA was seen arising from the inferior right aortic cusp measuring 2.1 x 1.5 cm that descended along the intraventricular septum without communication to the right ventricle. The coronary anatomy was usual and all cardiac chambers were of normal size and thickness. Transthoracic echocardiogram revealed an echo-lucent space anterior to the aortic valve and aortic root, suggestive of a paravalvular abscess, with regurgitant flow into the LVOT and possibly into the lower right atrium (RA) (Fig. 3). The patient’s preoperative LV EF was