Congenital aortic paravalvular tunnel masquerading as a recurrent ventricular septal defect

Abstract

A 4-year-old female underwent surgical repair of an unusual variation of an aorto-left ventricular tunnel (ALVT). Serial echocardiograms had demonstrated previous spontaneous closure of a perimembranous ventricular septal defect (VSD). The patient presented with concern for residual VSD which was later demonstrated to be an eccentric jet through an ALVT. This case emphasizes early and accurate diagnosis for ALVTs and how they can be misdiagnosed as VSDs.

Abnormal Color Flow Jet in Left Ventricular Outflow Tract Mimicking a Ventricular Septal Defect: Establishing Differentials and Diagnosis and Role of Transesophageal Echocardiography

“…Knowing the exact anatomical details of such complex lesions also helps reduce cardio-pulmonary bypass and aortic cross-clamp times. 8…”

“…When an abnormal communication between the aortic sinuses and LV, called an aortic paravalvular tunnel, arises between the RCC and NCC sinus, it can be misdiagnosed as a perimembranous VSD. 8 Eccentric AI being more commonly associated with bicuspid AVs and AVP should always be considered pathological. Furthermore, long-standing eccentric AI can lead to complications such as MV perforation, by being directed toward the annulus fibrosa and causing tissue trauma.…”

“…When an abnormal communication between the aortic sinuses and LV, called an aortic paravalvular tunnel, arises between the RCC and NCC sinus, it can be misdiagnosed as a peri-membranous VSD. 8…”

“…Knowing the exact anatomical details of such complex lesions also helps reduce cardio-pulmonary bypass and aortic cross-clamp times. 8 In conclusion, detection of abnormal CF jets in the LVOT or significant eccentric CF jets of AI warrants a detailed echocardiographic assessment. All available imaging modalities including 2D, CFD, spectral Doppler, MM, and 3DE should be used to characterize the abnormal jet, narrow down the differentials, formulate an accurate diagnosis, and guide appropriate management.…”