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CLINICAL RESEARCH: CONGENITAL HEART DISEASE

Aortico–left ventricular tunnel: 35-year experience

Jose D. Martins, MD^*, Megan C. Sherwood, MBBS, FRACP^*,*, John E. Mayer, Jr, MD and John F. Keane, MD^*

^* Department of Cardiology, Children's Hospital, Boston, Massachusetts, USA
Department of Cardiac Surgery, Children's Hospital, Boston, Massachusetts, USA
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA

Manuscript received February 5, 2003; revised manuscript received March 25, 2004, accepted April 6, 2004.

^* Reprint requests and correspondence: Dr. Megan Sherwood, Children's Hospital at Westmead, Hawkesbury Road, Westmead NSW 2145, Australia.
megans{at}chw.edu.au

OBJECTIVES: The purpose of this study was to review our 35 years of experience with aortico–left ventricular tunnel (ALVT), with emphasis on diagnosis, surgical details, and follow-up.

BACKGROUND: Aortico–left ventricular tunnel is a rare congenital anomaly. Neonatal surgery has been advocated in all due to long-term concern of valvar aortic regurgitation (AR).

METHODS: We identified 11 patients from 1963 to August 2002. Clinical, echocardiographic, catheterization, and surgical details were reviewed.

RESULTS: Eight of 11 patients presented at less than six months old (six with congestive heart failure) and three later with a murmur, all with clinical evidence of AR. Associated lesions, most commonly aortic valve and coronary artery anomalies, were present in 45%. Catheter occlusion was considered but not performed in five. Spontaneous occlusion was documented in one. Ten had surgery (nine in our institution), seven with direct suture and two by patch closure of the aortic end of the AVLT. At follow-up (median, 5 years; 1 month to 35 years), all were asymptomatic; three had residual ALVT (one moderate, two small/trivial), with at most mild AR.

CONCLUSIONS: Aortico–left ventricular tunnel is a rare cardiac malformation with a good post-operative long-term outcome. Associated lesions occurred in 45%. Catheterization should be reserved for patients with unclear non-invasive findings or transcatheter closure. We recommend surgery for most patients. We report spontaneous closure in one patient, prompting consideration of conservative follow-up in rare small, asymptomatic AVLT.

Abbreviations and Acronyms   ALVT = aortico–left ventricular tunnel   AoV = aortic valve   AR = aortic regurgitation   CHF = congestive heart failure   LV = left ventricle/left ventricular   RCA = right coronary artery

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