Aortopulmonary fistula after a modified Bentall procedure

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• Acute aortic dissection repair often involves composite conduits.
• Coronary artery anastomosis complications are infrequent but serious.

Observation:

• A 68-year-old man developed aortic pseudoaneurysm and aortopulmonary fistula three months post-surgery for acute aortic dissection.
• The complication stemmed from dehiscence of the left coronary button anastomosis.

Findings:

• Reoperation involved direct suture repair of the pulmonary trunk and coronary ostial anastomosis.
• Reinforcement with pericardial pledgets was used from within the aortic graft.

Implications:

• Aortopulmonary fistula from pseudoaneurysm is a rare proximal aortic surgery complication.
• This specific presentation, involving coronary anastomosis dehiscence, is exceptionally rare.
• Patients with acute aortic dissection, due to tissue fragility, are at higher risk.
• Early postoperative complications are possible, necessitating vigilant monitoring.
• Continuous follow-up is mandatory after composite conduit repair for acute aortic dissection.