Aortico-left ventricular tunnel.

Aortico-left ventricular tunnel (ALVT) is a very rare cardiac malformation with only 25 cases having been reported in the literature. This paper describes another 5 cases with surgical repair at the ages of 4, 5, 6, and 14 years, respectively. (A fifth case in an 11-year-old boy was operated upon just recently and is described separately in the addendum). The anatomical and clinical findings and diagnostic procedures including angiocardiography are reviewed. The surgical management is discussed, and the late results after follow-up periods of 5, 11, 13, and 16 years are presented. Three patients are doing well although showing clinical signs of mild aortic valve insufficiency, and one patient required aortic valve replacement 13 years after operation because of massive aortic regurgitation. Early surgical repair is recommended as soon as the diagnosis is established by angiocardiography in order to prevent secondary aortic valve lesion by dilatation of the aortic ring and aneurysmatic dilatation of the ventricular septum.