Aortico-Left Ventricular Tunnel

Type 1 - Slit-like tunnel without valve distortion
Type 2 - Aneurysm - extracardiac
Type 3 - Aneurysm - intracardiac
Type 4 - Aneurysm - both extracardiac and intracardiac.

From Kim & Spray. Sem Thorac Cardiovasc Surg, Pediatr Cardiac Surg Annu 2006:177-9.

Differential diagnosis for Ao-LV tunnel include
1) Sinus of Valsalva Aneurysm (Coronary artery origin will be above the level of aneurysm of SoV, while coronary artery origin will be below the tunnel origin in Ao-LV tunnel).
2) Coronary fistula (Origin of coronary artery will not be identifiable separate from the origin of the tunnel)
Of course, an eccentric jet of AR and paravalvar leaks with prosthetic valves provide similar color signals. But, these two will be obviously different.

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