Aortico - Left Ventricular Tunnel

AORTIC INSUFFICIENCY that results from an abnormal eommunication that begiiis in the aseending aorta above the level of the coronary arteries, bypasses the aortic valve, and terminates in the left ventricle is rare. Although clinical findings are similar, this condition may be distinguished anatomically from ruptured aortic sinus aneurysm because the abnormal communication which is to be presented here arises above the level of the coronary arteries (fig. 1). The purpose of this report is to record three cases of this condition, which we have chosen to call "aortico-left ventricular tunnel." All three patients were considered clinically as having congenital abnormalities of the aortic valve. Aortography was interpreted as showing aortic insufficiency. In one case, aortic sinus aneurysm was additionally diagnosed and, in another, a fistula arising in a coronary artery was suspected. When, in one case, the exact anatomical situation was determined by operation (fig. 2) and subsequent necropsy, it became obvious that the same fundamental problem was also present in the other two patients, and that a definitive operative procedure was available to them. Therefore, the latter two patients were recalled for operation, the abnormal communication was closed and,