Aortico-left ventricular tunnel (ALVT). A diagnostic and surgical "must"

ALVT is a rare congenital lesion. The paravalvular tunnel causes a clinical picture of aortic regurgitation. An aortic regurgitant murmur is present since birth. The clinical diagnosis, often overlooked, is best confirmed by angiocardiography in the lateral view. Although 80% of reported cases present with congestive heart failure before age 1, our two cases were asymptomatic at age 13 and 8 respectively. Both were operated on the basis of progressive left ventricular (L.V.) overload and dilatation. Diagnosis was made at operation in case 1 and suspected by the surgeon in case 2. Case 1 necessitated implantation of a bioprosthetic valve and replacement of the prosthesis 3 years later for primary tissue failure. Case 2 could be handled more conservatively with obturation of the aortic orifice of the tunnel. The natural evolution of the lesion involves progressive aortic valve regurgitation both by annuloectasia and retraction of the valve cusps. The diagnosis of ALVT should be considered in any infant or child with an aortic regurgitation murmur. Surgical treatment should be undertaken before alteration of the valve and the aim should be preservation of native valve function.