Imaging by multislice CT of a large aortico-left ventricular tunnel mimicking as ventricular septal defect

Aortico-left ventricular tunnel (ALVT) is a rare congenital cardiac anomaly that presents as paravalvular communication connecting the ascending aorta above the sinotubular junction and the left ventricle. In majority of cases the aortic orifice lies above the right coronary sinus (RCS). Clinically, most such cases present along with congestive heart failure. ALVT is associated with many cardiac anomalies like bicuspid aortic valve, patent ductus arteriosus and ventricular septal defect (VSD). Here we describe a case of ALVT that was misinterpreted as VSD initially on echocardiography. This report highlights the significance of multislice CT angiography (CTA) in accurate preoperative diagnosis of this rare entity.