A rare case report of an acquired aortopulmonary artery fistula after Bentall procedure: multimodality imaging approach may be the key?

Background: The acquired communication between the aorta and the pulmonary artery is a rare and potentially life-threatening condition. Its diagnosis is challenging and may require a multimodality imaging approach. Case summary: A 67-year-old Caucasian man, admitted for acute respiratory failure unresponsive to medical therapy and non-invasive ventilation, was diagnosed with an aortopulmonary fistula (APF) complicating a pseudoaneurysm of the aortic root. This condition developed after Bentall cardiac surgery, which entailed the use of a straight Dacron aortic graft coupled with a mechanical prosthesis. A multimodal imaging approach, combining echocardiography and computed tomography angiography, was diagnostic and supported the development of a surgical treatment strategy. The patient underwent successful surgical closure of the APF and correction of the aortic pseudoaneurysm. Discussion: Aortopulmonary fistula can result in rapid clinical deterioration if left untreated. The combination of echocardiography and computed tomography angiography techniques allowed for the diagnosis and surgical correction of the APF.

Early Obliterated Cabrol Shunt: Culprit of Aortopulmonary Fistula in Large Pseudoaneurysm after Bentall Procedure.

Aortopulmonary fistula secondary to a large pseudoaneurysm after a Bentall procedure is a rare but complex complication. Herein, we report a case of Cabrol shunt obliteration and pseudoaneurysm formation three months after a Bentall procedure. The patient also presented with congestive heart failure due to an aortopulmonary fistula six years later. Surgery was successfully performed to repair the dehiscence of the biliteral coronary ostia and the aortopulmonary fistula, and to replace the ascending aorta. Postoperatively, the patient recovered uneventfully.

Total arch and descending thoracic aortic replacement for massive hemoptysis requiring CPR caused by intrapulmonary penetration of chronic dissecting aortic aneurysm: a case report.

BACKGROUND: Intrapulmonary penetration of the thoracic aorta is a rare, life-threatening complication of a chronic dissecting aortic aneurysm. It causes massive hemoptysis requiring prompt intervention to prevent fatal airway bleeding. A surgical approach that enables diverse surgical maneuvers and intraoperative organ protection is crucial. CASE PRESENTATION: A 62-year-old man, who underwent graft replacement of the ascending aorta for an acute type A aortic dissection 20 months before, developed massive hemoptysis and cardiac arrest. The hemoptysis was secondary to an aortopulmonary fistula from a rapidly expanding dissecting aortic aneurysm. However, a successful return of spontaneous circulation was achieved with cardiopulmonary resuscitation, including establishment of veno-arterial extracorporeal membrane oxygenation. The patient successfully underwent a total arch and descending thoracic aortic replacement. This was achieved by a median sternotomy combined with a left thoracotomy using a straight incision with a rib-cross (SIRC) approach. The patient was uneventfully discharged and remained well for the following 2 years. CONCLUSIONS: When performing a surgical graft replacement for an aortopulmonary fistula with a thoracic aortic aneurysm, the surgical approach chosen is critical. A surgical procedure using a median sternotomy combined with a left thoracotomy and a SIRC approach can be an effective therapeutic option.

Aortopulmonary artery fistula: A rare complication of balloon dilatation of the pulmonary artery.

Acquired aortopulmonary fistula (APF) in the setting of repaired congenital heart disease is extremely rare but potentially fatal, so timely diagnosis and treatment are critical. We present a case of an 8-year-old female with a history of complex Taussig-Bing anomaly, who underwent an arterial switch procedure with LeCompte maneuver and ventricular septal defect closure early in life. The patient developed neopulmonary stenosis and branch pulmonary artery (PA) stenosis, for which she underwent patch augmentation and balloon dilatation of the left PA. The patient presented with a fistula between the ascending aorta and the left branch PA, confirmed by echocardiography and cardiac catheterization. She underwent repair of the APF with a homograft patch reconstruction of the ascending aorta.

Case Report: Simultaneous Ascending Aortic Dissection and Pulmonary Artery Dissection Combined by Aortopulmonary Fistula After Aortic Valve Replacement.

Aortopulmonary fistula with/without pulmonary artery dissection is an extremely rare and fatal complication of acute aortic dissection and is often discovered postmortem. We present a case with a simultaneous ascending aortic dissection and pulmonary artery dissection combined by aortopulmonary fistula after aortic valve surgery. However, the patient died of postoperative complications after surgery. Herein, the anatomical basis for this rare entity and its outcome is explored with an emphasis.

Reference values for 2-dimensional and M-mode echocardiography in Friesian and Warmblood horses.

BACKGROUND: Echocardiographic reference intervals for Friesian horses are poorly described. OBJECTIVES: To obtain reference intervals for echocardiographic measurements in Friesians and compare these with Warmbloods. ANIMALS: One hundred healthy adult Friesians and 100 healthy adult Warmblood horses. METHODS: Cross-sectional study. Two-dimensional and M-mode echocardiographic images were obtained. Echocardiographic measurements, including size, area, and volumetric measurements of left atrium, left and right ventricle, aorta, and pulmonary artery, were performed. Measurements were compared between the 2 breeds using an independent samples t test with Bonferroni correction for multiple comparisons. RESULTS: Reference ranges for standard echocardiographic measurements in Friesians were obtained. Several left ventricular measurements were significantly smaller in Friesians compared to Warmbloods, such as the left ventricular end-diastolic volume using the 4-chamber modified Simpsons' method (99.85% confidence interval for the difference [CI] = -245 to -63). Also the right ventricular end-diastolic and peak-systolic internal diameter were smaller in Friesians (99.85% CI = -1.33 to -0.6 and 99.85% CI = -1.54 to -0.76, respectively). Fractional shortening (99.85% CI = 0.61-6) and ejection fraction (99.85% CI = 0.21-4.6) were significantly larger. No structural effects of systemic hypertension, such as concentric hypertrophy, were detected. CONCLUSIONS AND CLINICAL IMPORTANCE: Our study provides reference intervals for echocardiographic measurements in Friesians useful in a clinical setting. In general, the left ventricular dimensions in Friesians were significantly smaller compared to Warmbloods, emphasizing the need for breed-specific reference intervals.

Acquired aortopulmonary fistula: a case report.

BACKGROUND: Aortopulmonary fistula is a rare complication of ascending aorta pathology. Presentation is most commonly dramatic with acute onset chest pain or heart failure secondary to left to right shunting. We describe a patient with acquired aortopulmonary fistula who had an insidious onset of heart failure as his presenting complaint. We also highlight the utility of multimodality cardiac imaging in establishing the diagnosis. CASE SUMMARY: A 79-year-old male patient with a history of coronary artery bypass graft surgery and mechanical aortic valve replacement, 23 years prior, presented with exertional dyspnoea of 7 months duration. An initial workup that included transthoracic and transoesophageal echocardiography as well as coronary and bypass graft angiography failed to diagnose an acquired aortopulmonary fistula complicating an ascending aortic pseudoaneurysm. Upon referral to our institution, the correct diagnosis was suspected on off-axis transthoracic echocardiography. The fistula was subsequently confirmed, and the extent of ascending aorta pathology defined via a multimodality imaging approach that consisted of transoesophageal echocardiography and cardiac computed tomography. The patient underwent successful surgical repair and was discharged in a stable condition. DISCUSSION: Acquired aortopulmonary fistula is a rare clinical entity. We describe a patient who had an insidious presentation of heart failure and found to have a large ascending aortic aneurysm that eroded into the main pulmonary artery creating a fistulous communication. The diagnosis was delayed and required a high index of suspicion and multimodality cardiac imaging.

Post-traumatic Aortopulmonary Fistula after Bentall Procedure.

Pseudoaneurysm complicated by aortopulmonary fistula (APF) after a Bentall procedure is extremely rare but potentially fatal, so timely diagnosis and treatment are critical. We present a subacute case of a post-traumatic APF which has had initial aspecific symptoms and later an acute worsening heart failure with chest pain not responding to medical treatment and requiring emergency surgery.

Aortopulmonary fistula related death - forensic implications.

A 79-year-old man with a history of arterial hypertension, insulin-dependent diabetes mellitus, renal insufficiency and thoracic endovascular aortic repair (TEVAR) was brought to the emergency department, following an episode of oliguria and urine retention. During chest X-ray he suddenly collapsed and died. Autopsy revealed a large atherosclerotic saccular thoracic aortic aneurysm whose right lateral wall firmly adhered to the right lung. There was more than 2.5 l of blood with fibrin deposits in the right part of the thoracic cavity. The right bronchus contained a cast of blood; blood was also present in the trachea and the distal airways of the right lung. Further dissection revealed that the aneurysm had eroded the tissue surrounding it and made a fistulous canal into the lower lobe of the right lung, causing the lung to fill with fluid blood. The cause of death was hemorrhage from the aortopulmonary fistula caused by pressure necrosis from the thoracic aortic aneurysm.

Pericardial Disease, Myocardial Disease, and Great Vessel Abnormalities in Horses.

Pericardial, myocardial, and great vessel diseases are relatively rare in horses. The clinical signs are often nonspecific and vague, or related to the underlying cause. Physical examination usually reveals tachycardia, fever, venous distension or jugular pulsation, a weak or bounding arterial pulse, ventral edema, and abnormal cardiac auscultation such as arrhythmia, murmur, or muffled heart sounds. The prognosis depends on the underlying cause and the disease progression, and ranges from full recovery to poor prognosis for survival. This article focuses on the etiology, diagnosis, prognosis, and treatment of pericarditis, pericardial mass lesions, myocarditis, cardiomyopathy, and great vessel aneurysm or rupture.

Two autopsy cases of rupture of the aorta by fistula formation after thoracic endovascular aortic repair and open stent-grafting on aortic arch aneurysm.

The mortality rate of aortic aneurysm/dissection is low in Japan. Two surgical procedures, the thoracic endovascular aortic repair (TEVAR) and the open stent-grafting have contributed much in survival of such aneurysmal patients. We encountered with two autopsy cases of death by aortic rupture with fistula formation after these procedures. Case 1 is an 85-year-old male who had the history of TEVAR for thoracic aorta aneurysm one and a half year before his death. His endovascular stent-graft was composed of a steel endoskeleton consisting of six Z-shape elements while at autopsy, one of the elements locating at the distal part was found inserted deep into the wall of descending aorta, causing aorto-esophageal fistula. Case 2 is an 88-year-old male who had the history of open stent-grafting for aortic aneurysm eight years ago. At autopsy, the stent-graft was found detached from aorta at its lesser curvature, causing gap formation between the aorta and the stent. Six Z-shaped stent elements, the parts of stent-graft, were found separated from descending aorta and located in the aneurism. Furthermore, three of the separated elements were found inserted deep in the aortic wall, causing aorto-pulmonary fistula. Since aorto-esophageal fistula formation after surgery for aortic aneurysm is very rare in TEVAR and there are no reported cases of death by aorto-pulmonary fistula in the open stent-grafting, these cases are reported here.

A Giant Aortic Arch Aneurysm with Aortopulmonary Fistula / 日本心臓血管外科学会雑誌

A 69-year-old woman complained of general malaise. Chest X-ray film revealed massive left-sided pleural effusion and CT detected a giant aneurysm of the aortic arch. A diagnosis of ruptured aortic arch aneurysm was made and she underwent total arch replacement as emergency surgery. The intraoperative diagnosis was not a ruptured arch aneurysm but an arch aneurysm penetrating into the left pulmonary artery. The postoperative course was uneventful and the patient was discharged home on the 16th postoperative day.

Treatment of a pseudoaneurysm of the ascending aorta in association with aortopulmonary fistula following acute Type A dissection.

This report describes a rare case of aortic pseudoaneurysm with an aortopulmonary fistula in a 69-year-old woman two years following repair of a Type A aortic dissection. The patient presented with NYHA Class IV symptoms having deteriorated rapidly over a course of six weeks. We describe our successful surgical repair following a failed attempt of percutaneous closure with an atrial septal occlusion device.

Thoracic aortic rupture in horses.

The aorta can rupture at the aortic root or aortic arch. In most breeds, the aortic root is the likely site and rupture leads to aortocardiac fistula with communication between the aorta and the right atrium, right ventricle and/or the interventricular septum. There is a high prevalence of aortic rupture in young Friesian horses and rupture occurs at the aortic arch with pseudoaneurysm and potentially aortopulmonary fistulation. Echocardiographic and post-mortem techniques must be adapted to identify aortic arch rupture that is not generally identified with standard approaches. Given the narrow genetic base of the Friesian breed and the significant differences found in extracellular matrix composition and metabolism between Friesians and Warmbloods, genetic factors are likely to contribute to the condition in the Friesian breed.

Iatrogenic "aortopulmonary window": percutaneous rescue closure as a bridge to surgical repair.

We present the case of a 15-year-old boy who underwent arterial switch operation due to transposition of the great arteries with severe scoliosis, obstruction of the right coronary ostium, and severe stenosis of the pulmonary trunk. Balloon angioplasty caused a large aortopulmonary shunt provoking myocardial ischaemia and pulmonary hypertension. The traumatic "aortopulmonary window" was percutaneously occluded using an Amplatzer Septal Occluder device as a bridge to surgical repair.

Transcatheter treatment of iatrogenic brachiocephalic-jugular arteriovenous fistula and aortopulmonary artery fistula: a case report.

Iatrogenic arteriovenous fistula is not a common complication of central venous catheterization. Duct occluder devices have been developed for patent ductus arteriosus occlusions but they may be used for arteriovenous fistula closures. We report a case of iatrogenic brachiocephalic-jugular and aortopulmonary artery fistulas after central venous catheter insertion. The fistulas were successfully managed with duct occluder devices. Due to increasing number of central venous catheterizations, physicians should be aware of this uncommon complication. Transcatheter closing of brachiocephalic-jugular and aortopulmonary artery fistulas by duct occluder devices seems to be a safe and feasible form of treatment.

A case of coronary artery-pulmonary artery fistula communicated with aorto-pulmonary fistula via common channel detected by Multidetector row CT (MDCT) and coronary angiography / 대한내과학회지

A congenital coronary artery fistula is a rare condition, which is an abnormal communication of the coronary artery with the ventricles or atriums or the pulmonary artery. A case of 69 year-old man, complaining of recent aggravating chest pain for 5 months is reported. The coronary angiography shows coronary artery-pulmonary artery fistula. Multidetector row CT shows coronary artery-pulmonary artery fistula combined with aortopulmonary fistula via common channel and the fistulas were surgically ligated.