Aorto-Right Atrium Fistula Caused by Detachment After Bentall's Operation: Report of a Case

Abstract

A 70-year-old woman was admitted to our hospital for treatment of right heart failure 16 years after undergoing Bentall's operation with a Cabrol shunt procedure. Various investigations showed detachment of the coronary artery and graft. We surmised that the heart failure was caused by a massive left to right shunt between a pseudoaneurysm of the wrapping aortic wall and the right atrium. Intraoperatively, we found a small fistula between the wrapping aortic wall and the right atrium, with complete closure of Cabrol shunt. We performed regrafting of the ascending aorta and reconstruction of the coronary ostium under cardiopulmonary bypass. The patient had an uneventful postoperative course. Detachment of the coronary ostium is a common long-term complication of Bentall's operation, but a Cabrol shunt between the wrapping aortic wall and the right atrium rarely causes congestive heart failure. A fistula between a pseudoaneurysm and the right atrium is even more unusual.

Complicated Course of Late Patient’s Survival After the Classic Bentall Procedure With the Cabrol Shunt

“…The case described in this article demonstrates that the shunt attached to the right atrium may open and cause the symptoms of heart failure decades after the operation. According to literature, spontaneous opening of the Cabrol shunt is particularly unusual and very few cases of this occurrence were reported in the past three decades [7,8]. Also, this case shows that even mild blood flow into the perigraft space may continuously increase the diameter of the native ascending aorta and subsequently disrupt anastomoses.…”

An unusual late complication associated with the Bentall procedure: pseudoaneurysm caused by button total detachment and aorto-right atrial fistula

“…Many cases of pseudoaneurysms have been reported, but the symptoms that our patient displayed are highly unusual. [7] However, the case reported by Ömeroğlu et al [8] was similar except that their patient experienced no coronary artery thrombosis and a large left-to-right shunt was not used during the procedure. Despite these differences, the clinical signs, such as inferior myocardial ischemia, were very similar, and the condition of our patient was also poor.…”

A Bentall Is Not a Bentall Is Not a Bentall: The Evolution of Aortic Root Surgery

“…He was confident that this communication would close spontaneously following the resolution of the coagulopathy after surgery and, if not, it would prove to be hemodynamically insignificant. In the years to follow, a number of reports of late complications owing to this connection were published in the literature [22,23]. Rather than drain the space, a method to decrease the permeability of the graft would achieve the same end.…”