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Case Reports
. 2021 Aug 20;14(8):e244029.
doi: 10.1136/bcr-2021-244029.

Severe obstructive sleep apnoea, aortic dissection and aortopulmonary fistula in a 56-year-old patient with syncope

Muzzamil Anwar Jelani  1 , Shravan Nosib  2
Affiliations
Case Reports

Severe obstructive sleep apnoea, aortic dissection and aortopulmonary fistula in a 56-year-old patient with syncope

Muzzamil Anwar Jelani et al. BMJ Case Rep. .

Abstract

We present a case of a 56-year-old patient with obstructive sleep apnoea (OSA) presenting with acute decompensated heart failure and signs of cardiogenic shock. Echocardiography and CT imaging led to the diagnosis of acute type A aortic dissection (AD) complicated by aortopulmonary fistula (APF). The patient underwent successful surgical repair with complicated postoperative course including pulseless electrical activity arrest. This case highlights the underappreciated role of untreated OSA as a risk factor for AD. Furthermore, it presents an opportunity to review APFs as a rare complication of AD. We discuss the available evidence linking OSA and AD, review currently reported cases of APF, briefly outline the haemodynamics of this acute left-to-right shunt and discuss management of this rare but deadly complication.

Keywords: Cardiovascular medicine; Cardiovascular system; Heart failure; Hypertension.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
CT angiogram showing rupture (yellow arrow) of the aorta into the pseudoaneurysm (red arrow), compressing the main pulmonary artery (purple arrow).
Figure 2
Figure 2
CT angiogram showing fistulisation of the right main pulmonary artery (yellow arrow), contained rupture of aorta (purple arrow) into pseudoaneurysm compressing the main pulmonary artery (red arrow).
Figure 3
Figure 3
Transoesophageal echocardiogram showing fistula (red arrow) from the aorta (yellow arrow) to the right main pulmonary artery (purple arrow) on the left. Abnormal flow from the aorta to the pulmonary artery shown on the right.
Figure 4
Figure 4
Transoesophageal echocardiogram showing a dissection plane starting at the sinotubular junction (red arrow), a true aortic lumen (purple arrow), the false lumen (blue arrow) and the aortic valve (yellow arrow).
See this image and copyright information in PMC

References

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