Aortico-left ventricular tunnel: An uncommon cause of aortic insufficiency in an infant

Abstract

ORTICO-LEFT ventricular tunnel (ALVT) is a rare congenital heart defect in which an anomalous channel connects the ascending aorta and left ventricle. This open channel causes severe aortic insufficiency. Since the initial descriptions of ALVT,‘-* there have been only 47 reported cases.3-11 The anesthetic management of one infant with ALVT undergoing total surgical closure of the anomalous channel is described since there are no previous reports of anesthesia care in these infants. RFPnRT nF A CASF ,._. _.., _. , . _, .__ At birth, the patient was a 940 g, 28-week gestation male. He was intubated and ventilated for 48 hours postpartum due to respiratory distress. A cardiac murmur was noted at one day of age and a subsequent echocardiogram demonstrated a possible ventricular septal defect. His 2-month hospital stay was complicated by jaundice, retrolental fibroplasia, bilateral inguinal hernias, and recurrent episodes of apnea and bradycardia. The patient did well at home until 8 months of age when he was hospitalized for congestive heart failure. Cardiac catheterization was thought to reveal an aneurysm of the sinus of Valsalva and severe aortic insufficiency. Following digitalization and diuresis, he was discharged, only to be readmitted 3 weeks later for congestive heart failure. At this time, he was referred to this institution for possible surgical