Acquired aortopulmonary fistula: a case report

Abstract

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.

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

“…Cases of acquired APF, following cardiac surgery or trauma, characterized by an insidious onset of heart failure that remained undiagnosed for months, have been previously reported. 10 , 11 In our case, the presentation of APF was dramatic, with an acute onset of refractory respiratory failure. In any scenario, however, irrespective of the presenting symptoms, a multimodal cardiac imaging approach was instrumental in establishing the diagnosis of APF.…”

What Flow is This!

“…[ 1 ] Acquired aortopulmonary fistulae have either prior aortotomy, percutaneous endovascular procedure, or acute aortic dissection as the underlying pathology. [ 2 , 3 ] Aortopulmonary fistulae have also been described in chronic diseases of the aortic wall, such as aneurysm, giant cell aortitis, syphilitic or mycotic disease, or endocarditis. [ 4 ] After accurate delineation of the anatomy, location, and size of the fistula is achieved, the patient can be treated by either open surgery, hybrid procedure, or endovascular stenting.…”