Aorto-left ventricular tunnel (T) is an abnormal communication between the ascending aorta and the left ventricle. The tunnel bypasses the normal ventriculoarterial junction but does not penetrate the septal musculature. The aortic orifice is distal to the level of the sinutubular junction, whereas the ventricular orifice is situated within the interleaflet triangle between the right and left aortic valvar leaflets.

This is in contrast with a sinus of Valsalva aneurysm, which originates proximal from the sinutubular junction within the right or non-coronary sinuses, seldom from the left. In the patient reported here a basically similar morphology of the tunnel was seen. After detection of a systolic–diastolic murmur in the 2nd month of life, cross sectional echocardiography and colour flow mapping confirmed an aorto-ventricular tunnel. (A) Echocardiography in the parasternal long axis view showing the extent of the tunnel between the aorta and left ventricle. (B) Parasternal short axis view demonstrating the tunnel and the Doppler flow forward into the aorta and regurgitant into the ventricle. (C) Anteroposterior view and (D) the lateral view of the thoracic aortogram showing the tunnel with a large extracardiac aortic wall aneurysm. (RV, right ventricle; LV, left ventricle; AO, aorta.)

Surgical correction was performed at the age of 19 months by double patch closure of the tunnel, preserving blood flow to the hypoplastic right coronary artery originating from the lateral wall of the tunnel. Twenty months after the operation there was grade I–II aortic incompetence.

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