Cardiocutaneous fistula

Abstract

Infection of the Teflon pledgets on the heart suture line after left ventricular aneurysm repair, presenting late with a fistulous tract connecting the heart with the skin (cardiocutaneous fistula) is an uncommon but potentially serious condition. The case is reported of a 73 year old man who developed a cardiocutaneous fistula extending through the left hemidiaphragm and draining at the abdominal wall, which developed six years after left ventricular aneurysmectomy. Following radiographic evaluation, which established the diagnosis, the Teflon pledgets and fistulous tract were successfully surgically removed. Prompt diagnosis depends on a high index of suspicion. Eradication of infection requires excision of infected material, which must be planned on an individual basis.

Figure 1

Following retrograde contrast fistula injection, the course and extent of the fistulous tract can be seen. The cardiocutaneous fistula (CF) originated from the left ventricle at the aneurysm repair site (black arrowheads) extended through the left hemidiaphragm (black arrow) and exited at the abdominal wall (white curved arrow).