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Aorto-right atrium fistula caused by detachment after Bentall's operation: report of a case

Yasuhito Sakano1, Yoshio Misawa, Yu-ichiro Kaminishi

  • 1Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.

Surgery Today
|March 8, 2007
PubMed

Insights

A rare complication after Bentall

Area of Science:

  • Cardiovascular Surgery
  • Medical Device Complications

Background:

  • Bentall's operation with a Cabrol shunt is a complex procedure for aortic root and ascending aorta pathologies.
  • Long-term complications can include graft detachment and pseudoaneurysm formation.

Observation:

  • A 70-year-old woman presented with right heart failure 16 years post-Bentall's operation with Cabrol shunt.
  • Investigations revealed coronary artery and graft detachment, and a pseudoaneurysm of the aortic wall.
  • A fistula was identified between the aortic pseudoaneurysm and the right atrium, with shunt closure.

Findings:

  • The heart failure was attributed to a massive left-to-right shunt between the aortic pseudoaneurysm and the right atrium.
  • This fistula formation, particularly with a closed Cabrol shunt, is an exceptionally rare cause of congestive heart failure.
  • Coronary ostium detachment is a known complication, but this specific shunt-related fistula is highly unusual.

Implications:

  • Highlights the importance of monitoring for rare, late complications following complex aortic surgeries.
  • Suggests that pseudoaneurysm formation in the aortic wall can lead to fistulas with adjacent cardiac structures.
  • Underscores the need for vigilance in diagnosing and managing unusual causes of heart failure in post-surgical patients.

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