Aorto–Left Ventricular Tunnel: Diagnostic Challenges and Surgical Management in a Child

Aorto–left ventricular tunnel (ALVT) is an exceptionally rare congenital extracardiac communication between the ascending aorta and the left ventricular outflow tract, causing continuous aortic regurgitant flow independent of the aortic valve. Untreated, it may cause progressive left ventricular volume overload and heart failure. We present a 4-year-old male child with Noonan syndrome who was incidentally diagnosed with ALVT during evaluation for a cardiac murmur. Multimodality imaging demonstrated a long extracardiac tunnel associated with patent ductus arteriosus (PDA) and patent foramen ovale (PFO). Surgical repair included PTFE patch closure of the ventricular end, closure of the aortic end with sinus plication, PDA ligation, and PFO closure. Recovery was uneventful, with preserved ventricular function and minimal residual aortic regurgitation. This case highlights the diagnostic challenges, surgical considerations, and importance of early intervention in preventing long-term complications.