Diagnosis of an aortico-left ventricular tunnel in a fetus: a case report

Abstract

An aortico-left ventricular tunnel is a rare congenital heart disease, and its prenatal diagnosis is even rarer. This report describes a fetus diagnosed with an aortico-left ventricular tunnel at 26 weeks of gestation. After delivery, the infant exhibited cyanosis and cessation of breathing. After resuscitation, he was transferred to the neonatal intensive care unit. Echocardiography confirmed an aortico-left ventricular tunnel. The infant survived after surgical repair. An aortico-left ventricular tunnel can be diagnosed by antenatal ultrasound, and prompt neonatal management can help to prevent perinatal morbidity and mortality.

Keywords: Aortico-left ventricular tunnel; case report; echocardiography; fetus; neonatal; prenatal diagnosis.

Figure 1.

(a–c) Echocardiographic images of the fetus at 26 weeks of gestation. (a) Left ventricular long-axis view showing the opening of the tunnel on the left ventricle side (yellow arrow), the ascending aorta side (green arrow), and the tunnel body (white arrow) (see Supplemental Online Video 1). (b) Color Doppler flow imaging of the aortico-left ventricular tunnel. The blood flow from the aortic valve margins to the left ventricle was retrograde in the diastolic phase and orthodromic in the systolic phase (see Supplemental Online Video 1). (c) Blood flow spectrum in the duct. The spectrum from the anomalous duct to the left ventricle was turbulent in the diastolic phase. The peak systolic velocity was 2.4 m/s. (d–g) Echocardiographic images were obtained 1 day after birth. (d) The left ventricular long-axis view showed the opening of the tunnel on the left ventricle side (yellow arrow), the ascending aorta side (green arrow), and the tunnel body (white arrow). (e) Color Doppler flow imaging of the aortico-left ventricular tunnel. The blood flowed into the left ventricular outflow tract through this tunnel (see Supplemental Online Video 2). (f) Spectrum of blood flow in the duct. The peak systolic velocity was 2.9 m/s. (g) The right and left coronary arteries were normal (white arrow). (h–i) Echocardiographic images after surgery. (h) Left ventricular long-axis view showing the surgical patch in the tunnel (yellow arrow). (i) Color Doppler flow imaging indicated no abnormal blood flow signal through the tunnel (yellow arrow).