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Case Reports
. 2024 May 7;8(5):ytae236.
doi: 10.1093/ehjcr/ytae236. eCollection 2024 May.

A rare case report of an acquired aortopulmonary artery fistula after Bentall procedure: multimodality imaging approach may be the key?

Monica Barki  1 , Stefania Sacchi  1 , Cecilia Marcolin  1 , Silvia Ajello  1 , Anna Mara Scandroglio  1
Affiliations
Case Reports

A rare case report of an acquired aortopulmonary artery fistula after Bentall procedure: multimodality imaging approach may be the key?

Monica Barki et al. Eur Heart J Case Rep. .

Abstract

Background: The acquired communication between the aorta and the pulmonary artery is a rare and potentially life-threatening condition. Its diagnosis is challenging and may require a multimodality imaging approach.

Case summary: A 67-year-old Caucasian man, admitted for acute respiratory failure unresponsive to medical therapy and non-invasive ventilation, was diagnosed with an aortopulmonary fistula (APF) complicating a pseudoaneurysm of the aortic root. This condition developed after Bentall cardiac surgery, which entailed the use of a straight Dacron aortic graft coupled with a mechanical prosthesis. A multimodal imaging approach, combining echocardiography and computed tomography angiography, was diagnostic and supported the development of a surgical treatment strategy. The patient underwent successful surgical closure of the APF and correction of the aortic pseudoaneurysm.

Discussion: Aortopulmonary fistula can result in rapid clinical deterioration if left untreated. The combination of echocardiography and computed tomography angiography techniques allowed for the diagnosis and surgical correction of the APF.

Keywords: Acute respiratory failure; Aortopulmonary fistula; Case report; Multimodality imaging approach.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Chest X-ray showing acute lung injury with bilateral involvement (acute respiratory distress syndrome—ARDS) in patient mechanically ventilated through the tracheostomy tube.
Figure 2
Figure 2
Transthoracic echocardiography and transoesophageal echocardiography images. Transoesophageal bicommisural view (A) demonstrating a mild to moderate dilation of the left ventricle. Transoesophageal short-axis view (B) showing the mechanical prosthetic aortic valve and the pseudoaneurysm of the aortic root. Continuous and pulsed wave Doppler at transthoracic echocardiography (C–D) demonstrating a normally functioning mechanical aortic valve (mean gradient 5.5 mmHg, max. velocity 1.7 m/s, DVI 0.7). Zoomed short-axis transoesophageal view (E–F) exhibiting the voluminous pseudoaneurysm with the colour Doppler demonstrating the communication of the pseudoaneurysm with the pulmonary artery with a left-to-right shunt.
Figure 3
Figure 3
Contrast computed tomography angiography images in oblique axial reconstruction demonstrating the voluminous pseudoaneurysm of the aortic root (left) and the aortopulmonary fistula (right).
Figure 4
Figure 4
Post-operative contrast computed tomography angiography images in oblique axial reconstruction demonstrating the complete resolution of the aortopulmonary fistula (APF).
See this image and copyright information in PMC

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