Diagnosis and management of aorto-left ventricular tunnel

Abstract

Background:Aorto-left ventricular tunnel (ALVT) is a rare congenital extracardiac channel with progressive left ventricular dilatation needs early correction.Materials and Methods:This is a report of diagnosis and management of aorto-left ventricular tunnel (ALVT) over a period of 11 years from a single institution. Seven patients (age range: 7 days-45 years) presented with heart failure. The diagnosis of ALVT was made by transthoracic echocardiogram in all cases.Results:Treatment was refused by two patients who died during follow-up. Surgical closure of the tunnel was done in four cases, of which one needed Bentall procedure. Two patients had residual leak after the surgery. Transcatheter closure using Amplatzer muscular device was performed in two cases (for postoperative residual leak in one and primary procedure in the other). Significant hemolysis developed in one of them, necessitating the removal of the device and closed surgically. This child underwent aortic valve replacement two years later. All the remaining patients were doing well during the median follow-up of 30 months (range: 1.5-9 years).Conclusion:ALVT is a rare and potentially fatal anomaly that is ideally managed surgically. Catheter closure has a limited role.

Aorto-left ventricular tunnel with anomalous origin of right coronary artery and bicuspid aortic valve: a case report

“…Clinical onset and progression of heart failure ranges from birth to adulthood, with a majority of the patients developing symptoms in their first year [ 4 ]. Associated anomalies of ALVT include proximal coronary abnormalities like coronary ostium originating within the tunnel or atresia of coronary ostium, and aortic valve abnormalities such as dysplastic or bicuspid valve with stenosis [ 5 ]. To our knowledge, no case has been so far reported as ALVT with both AORCA and BAV.…”

A Review of the Surgical Management of Aorto-ventricular Tunnels

“…Of these patients, 96 (43.6%) were below one month of age (mean + SD ¼ 3.84 + 6.3 days), while 37 (16.8%) patients were more than 14 years old. 11,13,16,27,28,59,60,62 In the joint multicenter registry, median age at diagnosis and operation in those with left ventricular tunnels was 25 days (1 day-25 years), with 28 (77.8%) patients undergoing surgery before the age of 6 months. 95 In those with right ventricular tunnels, the median age at diagnosis was six years (1 month-12 years).…”

“…As stated above, we were able to find 37 reports of patients presenting beyond the age of 14 years. 11,13,16,27,28,59,60,62,95…”

Tunel aortalno-lewokomorowy — rzadka przyczyna szmeru skurczowo-rozkurczowego

“…Since first reported as a congenital lesion in 1963, aortico--ventricular tunnel (AVLT) has been a very rare congenital channel between the ascending aorta above the sino--tubular junction proximally to the cavity of the left (90%), or less commonly the right (10%), ventricle distally [1]. This is an exceedingly rare anomaly, with incidence as low as 0.001% of all congenital cardiac diseases [2]. The onset, severity and progression of the disease vary from in-utero foetal demise to asymptomatic adulthood [2].…”

“…This is an exceedingly rare anomaly, with incidence as low as 0.001% of all congenital cardiac diseases [2]. The onset, severity and progression of the disease vary from in-utero foetal demise to asymptomatic adulthood [2]. The onset of heart failure involves interplay between the cross-sectional area of tunnel and the amount of aortic regurgitation.…”