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Aortico left ventricular tunnel (ALVT) is a rare, abnormal paravalvular communication between the aorta and the left ventricle.1 After the first description by Edwards in 1961, approximately 130 cases have been reported in the literature. However, there are only a few reports of ALVT associated with severely stenotic bicuspid aortic valve.2
The aetiology of aortico-ventricular tunnel is unknown. The formation of the tract is considered as a consequence of primary separation of the aortic annulus from the fibrous skeleton of the heart. The failure of normal development of the tissue plane between the facing aortic and pulmonary sinuses is another proposed mechanism. Other hypotheses include an abnormal coronary artery, the early or intrauterine rupture of a sinus of Valsalva …
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