Surgical treatment of aortico-left ventricular tunnel

Thirteen children (age range 6 h-11 years, median 4 months) operatedupon for aortico-left ventricular tunnel since 1971 are reported. Allpatients had systolic and diastolic murmurs, 4 of 5 neonates were in severecongestive heart failure. Twelve children had left ventricular hypertrophyon ECG with an ischaemic pattern in the neonates. Chest X- ray revealedcardiomegaly with a broad upper mediastinal shadow from the enlarged aorta.Echocardiography (2DE) revealed a tubular communication between the aortaand the left ventricle bypassing the aortic valve and massive regurgitationthrough this tunnel demonstrated by Doppler sonography. In 8 patients, thediagnosis was confirmed by angiography. The tunnel arose from the rightcoronary sinus in 12 and from the left coronary sinus in 1 patient. Thetunnel was closed at both ends in 8, at the aortic end only in 3 and at theventricular end in the remaining 2 cases. One 6-day-old infant, operatedupon in 1971 died postoperatively. There was 1 non-cardiac related latedeath due to a brain tumour. Echocardiographic analysis of left ventricularsize and function was carried out in 9 children up to 39 months aftersurgery. Mild to moderate aortic incompetence was detected during thefollow-up period in 2 of 12 patients. All surviving children are leadingnormal lives.