An acquired aortopulmonary fistula is a rare and usually fatal phenomenon. Rarer still are reports of successful surgical repair of aortopulmonary fistulae. We present the case of a 48-year-old hypertensive man who presented with congestive cardiac failure. Examination revealed a bicuspid aortic valve and a large aneurysm of the arch of the aorta, which was communicating with the main pulmonary artery. The diagnosis of acquired aortopulmonary fistula was made using transthoracic echocardiography findings and confirmed by CT. The patient was successfully managed by surgery, with an uneventful postoperative recovery, with control of congestive cardiac failure. At 1-year follow-up, the patient had Class I symptoms.
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