The aorto-ventricular tunnels

Abstract

LEVY AND COLLEAGUES, IN 1963, WHO ARE generally credited with the first description of “aortico-left ventricular tunnel”.1 Examples of the malformation, nonetheless, were illustrated initially by Burchell and Edwards in 1957,2 and by Edwards in 1961.3 The subsequent documentation of more than 130 cases has now elucidated many features of the so-called “tunnels,” including their clinical presentation and surgical management. While most of the abnormal channels extend between the aorta and the left ventricle,4–79 it is now also recognized that some, alternatively, enter the right ventricle.80–91 The anatomic arrangement underscoring the malformations has been clarified by recent morphological studies,92,93 while diagnosis during fetal life has established beyond any doubt that the lesions are congenital.42,43 Although rare, the aorto-ventricular tunnel is the foremost cause during infancy of regurgitant flow of blood from the aorta to one or the other of the ventricles. In this review, we will describe and illustrate the structure of the malformations, speculate upon their developmental basis, and discuss pertinent aspects of their diagnosis and treatment.