Aortico-left ventricular tunnel: a rare differential diagnosis of congenital aortic regurgitation

Aortico-left ventricular tunnel (ALVT) is a rare congenital cardiac malformation that presents with cardiac failure and clinical findings of severe aortic regurgitation in early infancy. The diagnosis should be made with 2-D echocardiography by demonstrating an abnormal tunnel-like structure that connects the ascending aorta with the left ventricle. Up to 45% of the patients may have associated cardiac defects, and the development of this bizarre lesion is still unclear. In contrast to congenital aortic regurgitation, ALVT has a better prognosis. Early surgical intervention is curative, but non-operated children die because of heart failure. Therefore, knowledge of this rare cardiac malformation is mandatory if an infant presents with findings of aortic regurgitation.