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Chirurgia 2008 June;21(3):155-7

language: English

An occurrence of aortobronchial fistula undiagnosed by conventional modalities forty-four years after coarctation repair

Messner G. N. 1, Forrester M. D. 3, Kennedy D. M. 2, Smith R. D. 2, Sartori M. P. +, Gregoric I. D. 2

1 Department of Cardiovascular Surgery,Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas, USA
2 Department of Cardiopulmonary Transplantation, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas, USA
3 Department of Cardiovascular Surgery Research, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas, USA


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We report a case of aortobronchial fistula that occurred 44 years after a coarctation repair and that was undiagnosed by conventional means. A 63-year-old man reported dyspnea and occasional hemoptysis. Bronchoscopy and chest computed tomography findings were normal, but echocardiography showed severe aortic stenosis, which was addressed by implantation of a bioprosthetic aortic valve. The patient subsequently reported increasingly frequent streaky hemoptysis. Repeat bronchoscopy and aortography showed no additional pathology, but an exploratory thoracotomy revealed a communication between the lung and the aorta at the site of an old pledget. A wedge resection was performed on the involved lung, the aorta was repaired directly, and a bovine pericardial patch was placed over the repair to prevent any further contact with the lung. The patient recovered without complications. Aortobronchial fistula should be suspected in any patient with hemoptysis and a history of thoracic aortic surgery, even if a conventional workup does not reveal the fistula.

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