Aortic-Left Ventricular Tunnel with Late Incompetence after 18-year Follow-Up

Introduction

Since Levy introduced the first case of aortic-left ventricular tunnel (ALVT), hundreds of cases have been described in the literature. All authors agree that the earlier the operation is performed, the better the outcome will be, and that operative procedures should include patch repair of the aortic orifice and/or ventricular orifice, or direct suture of the tunnel. The long-term results nevertheless include progressive aortic regurgitation (AR) and a need for a second operation for aortic valve repair or replacement. Our patient received tunnel repair when he was 5 months old [[1]] and valve replacement at 19 years of age. The unique changes in the aortic valve and surrounding structure are described below.

References

• 1 Chen Y F, Chiu C C, Wu J R. Correction of aortico-left ventricular tunnel in a small Oriental infant: a brief clinical review.  J Cardiovasc Surg. 1994;  35 71-73
• 2 Duveau D, Baron O, Michaud J L, Lefevre M, Laboux L, Dupon H. Aortico-left ventricular tunnel. Long-term follow-up, therapeutic implications.  Arch Mal Coeur. 1989;  82 785-789
• 3 Honjo O, Ishino K, Kawada M, Ohtsuki S I, Akagi T, Sano S. Late outcome after repair of aortico-left ventricular tunnel: 10-year follow-up.  Circ J. 2006;  70 939-941
• 4 Sousa-Uva M, Touchot A, Fermont L, Piot D, Delezoid A L. Aortico-left ventricular tunnel in fetus and infants.  Ann Thorac Surg. 1996;  61 1805-1810
• 5 Serino W, Andrade J L, Ross D, DeLeval M, Somerville J. Aortico-left ventricular communication after closure: late post-operative problems.  Bri Heart J. 1983;  49 501-506
• 6 Martins J D, Sherwood M C, Mayer J E, Keane J F. Aortico-left ventricular tunnel: 35-year experience.  J Am Coll Cardiol. 2004;  44 446-450
• 7 Meldrum-Hanna W, Schroff R, Ross D N. Aortico-left ventricular tunnel: late follow-up.  Ann Thorac Surg. 1986;  42 304-306
• 8 Kakadekar A P, Sandor G S, Patterson M W, LeBlanc J G. Role of transesophageal echocardiography in the management of aortico-left ventricular tunnel.  Pediatric Cardiology. 1995;  16 137-140