CASE REPORTS  CARDIAC PAPERS 

The Journal of Cardiovascular Surgery 1998 December;39(6):817-9

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Aorto-atrial fistula associated with recurrent aortic dissection after ascending aorta replacement

Fujii H., Oka T., Kawaguchi H., Kido M., Ninomiya H., Osako M., Otani H., Imamura H.

From the Department of Thoracic and Cardiovascular Surgery Kansai Medical University, Moriguchi, Osaka, Japan

A 70-­year-old wom­an ­with a bicus­pid aor­tic ­valve had under­gone ascend­ing aor­ta replace­ment for ­acute DeBakey ­type I dis­sec­tion. Computed tomog­ra­phy and aor­tog­ra­phy 2 ­months ­after the oper­a­tion ­revealed a throm­bosed ­false ­lumen in the ascend­ing aor­ta prox­i­mal to the pros­thet­ic ­graft. However, recur­rence of dis­sec­tion was ­found at the aor­tic ­root prox­i­mal to the ­graft 4 ­years ­after the ­initial oper­a­tion. Significant aor­tic sten­o­sis was ­also not­ed. Despite inten­sive med­i­cal treat­ment, she had refrac­to­ry and pro­gres­sive ­heart fail­ure. At the sec­ond sur­gery, an aor­to-­right atri­al fis­tu­la, ­which prob­ably was respon­sible for the ­severe ­heart fail­ure was ­revealed. Closure of the aor­to-­right atri­al fis­tu­la, and aor­tic ­root replace­ment ­were per­formed ­using Piehler’s meth­od, ­with a com­pos­ite ­graft. The eti­ol­o­gy and man­age­ment of ­this ­rare ­case are dis­cussed.