Surgical treatment of aortic-left ventricular fistula

Aortico Left Ventricular Tunnel (ALVT) is a rare congenital anomaly. It presents as an asymptomatic murmur to severe Aortic Regurgitation (AR) and heart failure. Most of the patients have heart failure in first year of life. Method: We present a review of the relevant literature and 20 recent articles with case presentations. Patient rarely present beyond second decade of life. Here we report a 40-year male with previous MI, angina pectoris, he presented with dyspnea on minimal exertion and chest pain for 1 month, and unusual type of ALVT, who presented with heart failure and conduction disturbances. Discussion: The differential diagnosis of aortico-Left ventricular tunnel includes lesions which produce prominent to-and from murmurs. In the neonatal period, the first three of these conditions are difficult to differentiate by noninvasive means. Conclusions: Aortico–left ventricular tunnel is a rare cardiac malformation with a good long-term outcome after surgery. Echocardiography can identify the ALVT and associated lesions and is the diagnostic investigation of choice. Diagnosis of ALVT is an indication for operation. Conservative management may be considered in rare, asymptomatic, small AVLT as observed spontaneous closure in one such patient.