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Barki M, Sacchi S, Marcolin C, Ajello S, Scandroglio AM. A rare case report of an acquired aortopulmonary artery fistula after Bentall procedure: multimodality imaging approach may be the key? Eur Heart J Case Rep 2024; 8:ytae236. [PMID: 38774774 PMCID: PMC11106585 DOI: 10.1093/ehjcr/ytae236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/18/2024] [Accepted: 05/03/2024] [Indexed: 05/24/2024]
Abstract
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.
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Affiliation(s)
- Monica Barki
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Stefania Sacchi
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Cecilia Marcolin
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Silvia Ajello
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Anna Mara Scandroglio
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy
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Early Obliterated Cabrol Shunt: Culprit of Aortopulmonary Fistula in Large Pseudoaneurysm after Bentall Procedure. J Cardiovasc Dev Dis 2022; 9:jcdd9120449. [PMID: 36547447 PMCID: PMC9781270 DOI: 10.3390/jcdd9120449] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
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.
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Izzo D, Savino K, Castellani C, Sperandini L, Ragni T, Ambrosio G, Cavallini C. Post-traumatic Aortopulmonary Fistula after Bentall Procedure. J Cardiovasc Echogr 2020; 30:29-32. [PMID: 32766103 PMCID: PMC7307618 DOI: 10.4103/jcecho.jcecho_5_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/25/2020] [Accepted: 03/09/2020] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Daniela Izzo
- Department of Cardiology and Cardiovascular Physiopathology, University of Perugia, Perugia, Italy
| | - Ketty Savino
- Department of Cardiology and Cardiovascular Physiopathology, University of Perugia, Perugia, Italy
| | | | | | | | - Giuseppe Ambrosio
- Department of Cardiology and Cardiovascular Physiopathology, University of Perugia, Perugia, Italy
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Kitamura T, Torii S, Kobayashi K, Tanaka Y, Sasahara A, Araki H, Ohtomo Y, Horikoshi R, Miyaji K. Repeat surgical intervention after aortic repair for acute Stanford type A dissection. Gen Thorac Cardiovasc Surg 2018; 66:692-699. [PMID: 30078149 DOI: 10.1007/s11748-018-0983-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 08/01/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to evaluate the outcomes of repeat interventions on the aorta and aortic valve after surgery for acute Stanford type A aortic dissection. METHODS The hospital records of patients who underwent repeat surgical intervention between April 2011 and March 2017 for late complications after acute type A aortic dissection repair were retrospectively reviewed. RESULTS We identified 17 patients with mean age of 62 ± 8 years; 13 were men. The mean interval from the initial emergency aortic repair to the repeat intervention was 5.8 ± 5.4 years (range 133 days-16.6 years). Ten patients had dilatation or rupture of the residual type B aortic dissection; six of them had retrograde type A aortic dissection at the onset and did not undergo resection of the primary entry. Five patients had a pseudoaneurysm at the anastomosis; four of them were receiving anticoagulation medication. Three patients had aortic regurgitation; two of them were associated with the gelatin-resorcinol-formaldehyde glue that was used during the initial surgery. There was no early mortality after repeat intervention and no late death after a mean follow-up period of 3.3 ± 2.0 years. CONCLUSIONS Repeat surgical intervention on the aorta and aortic valve after repair of acute type A aortic dissection had favorable early and mid-term outcomes and was not associated with early or late death. Long-term follow-up with imaging and echocardiography was considered to be essential for early detection of residual type B dilatation, anastomotic pseudoaneurysm, and aortic regurgitation after initial aortic repair.
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Affiliation(s)
- Tadashi Kitamura
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Shinzo Torii
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
| | - Kensuke Kobayashi
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
| | - Yuki Tanaka
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
| | - Akihiro Sasahara
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
| | - Haruna Araki
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
| | - Yuki Ohtomo
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
| | - Rihito Horikoshi
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
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Mitral Valve Necrosis After Cardiac Surgery Using Gelatin-Resorcinol-Formaldehyde Glue. Ann Thorac Surg 2017; 103:e435-e436. [DOI: 10.1016/j.athoracsur.2016.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/10/2016] [Accepted: 10/05/2016] [Indexed: 11/22/2022]
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Karangelis D, Raju S, Dimarakis I, Roubelakis A, Fragoulis S. Treatment of a pseudoaneurysm of the ascending aorta in association with aortopulmonary fistula following acute Type A dissection. Perfusion 2016; 32:84-86. [PMID: 27440801 DOI: 10.1177/0267659116660186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
| | - Sneha Raju
- 2 Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Wakefield BJ, Winter D, Alfirevic A. Staged Repair of an Aortopulmonary Fistula From a Large Ascending Aortic Pseudoaneurysm: The Role of Transesophageal Echocardiography. J Cardiothorac Vasc Anesth 2016; 30:1329-33. [PMID: 27041238 DOI: 10.1053/j.jvca.2015.11.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Indexed: 11/11/2022]
Affiliation(s)
| | - Daniel Winter
- Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH
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Muretti M, Massi F, Coradduzza E, Portoghese M. Pseudoaneurysm fistulized into pulmonary artery 13 years after aortic surgery. Asian Cardiovasc Thorac Ann 2015; 25:52-54. [PMID: 26542784 DOI: 10.1177/0218492315614423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pseudoaneurysm formation some years after aortic root or ascending aorta surgery, complicated by fistula formation through a branch of the pulmonary artery, is a rare condition described only in case reports. We describe a case of this rare complication in a 58-year-old man, which occurred 13 years after aortic surgery and was characterized by a huge pseudoaneurysm of 70 mm that fistulized into the right pulmonary artery, causing a life-threatening situation.
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Affiliation(s)
- Mirko Muretti
- Department of Cardiac Surgery, Santissima Annunziata Hospital, Sassari, Italy
| | - Francesco Massi
- Department of Cardiac Surgery, Santissima Annunziata Hospital, Sassari, Italy
| | - Enrico Coradduzza
- Department of Cardiac Surgery, Santissima Annunziata Hospital, Sassari, Italy
| | - Michele Portoghese
- Department of Cardiac Surgery, Santissima Annunziata Hospital, Sassari, Italy
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Sadat K, Pradhan M, Nanda NC, Joshi D, Diddi HP. Two- and three-dimensional transthoracic echocardiography in the assessment of aortic arch vasum vasi to pulmonary artery fistula. Echocardiography 2013; 30:219-24. [PMID: 23305062 DOI: 10.1111/echo.12090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
We report an elderly patient presenting with a stroke and also hemolytic anemia secondary to mitral and tricuspid valve repair 3 years earlier, in whom two-dimensional transesophageal echocardiography (2DTEE) suspected a fistula into the pulmonary artery (APAF) from the posterior wall of the aortic arch. For further assessment, two-dimensional transthoracic echocardiography (2DTTE) and live/real time three-dimensional transthoracic echocardiography (3DTTE) were performed. 2DTTE showed findings similar to 2DTEE. Color Doppler guided continuous-wave Doppler showed continuous flow throughout the cardiac cycle with systolic preponderance across the fistula with a small peak pressure gradient of 22 mmHg. Sequential systematic cropping of the 3D datasets obtained from 3DTTE confirmed that the flow signals originated from the posterior wall of the aortic arch and not the lumen. Thus, 3DTTE served to increase the confidence level that the fistula most likely originated from a vasum vasi in the wall of the aortic arch. To our knowledge, this type of fistula has not been reported previously. Fistulas from the aortic lumen to the pulmonary artery are also rare and so far only 24 cases have been reported in the literature. These are also reviewed by us.
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Florescu M, Benea DC, Cerin G, Lanzillo G, Diena M, Cernigliaro C, Cinteza M, Vinereanu D. Aorto-pulmonary fistula as a late complication of multiple valve replacement after Streptococcus Bovis endocarditis in a patient with occult colon carcinoma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2009; 37:369-373. [PMID: 19253356 DOI: 10.1002/jcu.20562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We report a case of aorto-pulmonary fistula following multiple valve surgery in a patient with colon carcinoma who had had recurrent episodes of Streptococcus Bovis endocarditis. Diagnosis was made by transesophageal echocardiography and aortography. Patient underwent emergency percutaneous implantation of an aortic endoprosthesis, but he continued to deteriorate and the fatal outcome could not be changed. This case underscores the importance of examination of gastrointestinal tract in patients with Streptococcus Bovis endocarditis.
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Affiliation(s)
- Maria Florescu
- Department of Cardiology, University and Emergency Hospital of Bucharest, Bucharest, Romania
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Atik FA, Navia JL, Svensson LG, Vega PR, Feng J, Brizzio ME, Gillinov AM, Pettersson BG, Blackstone EH, Lytle BW. Surgical treatment of pseudoaneurysm of the thoracic aorta. J Thorac Cardiovasc Surg 2006; 132:379-85. [PMID: 16872966 DOI: 10.1016/j.jtcvs.2006.03.052] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Revised: 02/24/2006] [Accepted: 03/08/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To examine the clinical profiles, operative outcomes, and late results of patients with pseudoaneurysm of the thoracic aorta. METHODS From 1990 to 2002, 60 patients underwent repair of aortic pseudoaneurysm: ascending aorta in 70%, ascending aorta and arch in 15%, descending aorta in 10%, and arch alone in 5%. Mean age was 53 +/- 15 years, and 70% were men. Of these, 50 (83%) had undergone previous cardiac surgery, including 22 (37%) composite valve graft operations. The preferred cannulation site was femoral-femoral (n = 27, 45%), with deep hypothermic circulatory arrest in 62% and retrograde cerebral perfusion in 33%; more recently, however, axillary cannulation has been preferred. RESULTS Principal etiologies were graft infection in ascending aorta pseudoaneurysm and trauma in descending aorta pseudoaneurysm. Fifteen patients (25%) presented with chest pain, 13 (22%) with heart failure, and 20% with moderate or severe aortic regurgitation. The pseudoaneurysm was resected and the aorta replaced (n = 45, 75%) or repaired (n = 15, 25%) using various methods. Hospital mortality was 6.7% (n = 4). Reexploration for bleeding was required in 8.3%, and 3.3% had postoperative stroke. At 30 days, 5 years, and 10 years, survival was 94%, 74%, and 60% and freedom from reoperation was 95%, 77%, and 67%, respectively. CONCLUSIONS Most patients with aortic pseudoaneurysm require ascending aorta and/or arch replacement, which can be accomplished with low operative mortality and morbidity. Long-term survival and freedom from reoperation in these young patients parallel those expected for complex cardiac and aortic disease.
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Affiliation(s)
- Fernando A Atik
- Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio
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Maeder MT, Wolber T, Künzli A, Genoni M, Blank R, Rickli H. Aortopulmonary Fistula Occurring 4 Years After Replacement of the Ascending Aorta. Ann Thorac Surg 2006; 81:e18-20. [PMID: 16631631 DOI: 10.1016/j.athoracsur.2006.01.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Revised: 01/02/2006] [Accepted: 01/05/2006] [Indexed: 11/25/2022]
Abstract
A 62-year-old man presenting with congestive heart failure due to a fistula between an aortic pseudoaneurysm and the right pulmonary artery is described. The shunt occurred 4 years after aortic valve and supracoronary graft replacement and was diagnosed by transesophageal contrast echocardiography. After redo surgery the patient made an uneventful recovery.
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Affiliation(s)
- Micha T Maeder
- Division of Cardiology, Department of Internal Medicine, Kantonsspital St. Gallen, Switzerland.
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