Aortico-left ventricular tunnel associated with single coronary artery in an infant

Aortico-left ventricular tunnel (ALVT) is a rare congenital malformation in which an abnormal communication between the aorta and the left ventricle (LV) bypasses the aortic valve. In infants, it usually presents with congestive heart failure. The clinical presentations mimic aortic regurgitation or ruptured sinus of Valsalva aneurysm into the LV. Progressive aortic regurgitation is a common problem in patients with ALVT. ALVT associated with a single coronary artery is extremely rare. We report the case of an infant who had congestive heart failure caused by ALVT. The diagnosis was made by echocardiography and angiography. In addition, a single coronary artery from the noncoronary cusp was found during surgery. Congestive heart failure resolved after successful surgical repair and he was asymptomatic throughout 2 years of follow-up. This case illustrates that early diagnosis of ALVT and corrective surgery can prevent aortic valve incompetence and is associated with a good clinical outcome.