[An aortopulmonary shunt after a knife wound]

An extensive hemopneumothorax developed in a 23-year-old man after having been knifed in the region of the left nipple. After general surgical care a Bülau suction drain was inserted. Cardiological examination became necessary a week later when a chest X-ray film demonstrated an enlarged cardiac silhouette. Echocardiography revealed pericardial effusion (about 600 ml) which was removed by pericardial aspiration. Cross-sectional and colour Doppler echocardiography showed a shunt between the aorta and right ventricular outflow tract at the origin of the pulmonary artery. At surgery a fistula between the root of the aorta and the pulmonary artery was identified (the posterior sinus near the anulus was nearly completely detached). The fistula was closed and the pulmonary valve reconstructed. The early and late postoperative course was unremarkable.