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.

Echocardiography, when carried out in patients with acute rheumatic fever diagnosed strictly according to the Jones criterion, can avoid both overdiagnosis and underdiagnosis of carditis. A high incidence of carditis, or subclinical carditis, is detected by echocardiography when performed in patients with rheumatic chorea or arthralgia.