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Cardiogastric fistula occurring 9 years after resection of left ventricular aneurysm
J P Grande1, P A Pellikka, W D Edwards
1Division of Pathology, Mayo Clinic, Rochester, MN 55905.
Insights
A rare cardiogastric fistula developed 9 years after left ventricular aneurysm repair, leading to fatal gastrointestinal bleeding. This case highlights a severe late complication of aneurysmectomy without prior gastrointestinal issues.
Area of Science:
- Cardiology
- Gastroenterology
- Pathology
Background:
- Left ventricular pseudoaneurysms can occur after myocardial infarction and surgical repair.
- Late complications following aneurysmectomy are uncommon but can be severe.
Observation:
- An 83-year-old male presented with fever, anemia, and heart failure 9 years post-left ventricular aneurysm repair.
- Despite extensive gastrointestinal evaluation, no ulcer disease was found.
- The patient experienced massive hematemesis and melena, leading to death.
Findings:
- Autopsy revealed a fistula between a left ventricular pseudoaneurysm and the stomach (cardiogastric fistula).
- Infection of the pseudoaneurysm is suspected as the cause of gastric perforation.
- This is the first reported case of a cardiogastric fistula as a late complication of aneurysmectomy in the absence of primary gastrointestinal pathology.
Implications:
- This case underscores the potential for rare, life-threatening late complications after left ventricular aneurysm repair.
- Highlights the importance of considering cardiogastric fistula in patients with a history of cardiac surgery presenting with unexplained gastrointestinal bleeding.
- Suggests that infected pseudoaneurysms can directly lead to gastrointestinal tract perforation.
Abstract:
An 83-year-old man, 9 years after repair of a postinfarction aneurysm of the left ventricle, developed fever, anemia, and congestive heart failure. Extensive evaluation of the gastrointestinal tract revealed no evidence of ulcer disease. While in the hospital, he developed massive hematemesis and melena and died 2 days later. At autopsy, a communication existed between a left ventricular pseudoaneurysm and the stomach to form a cardiogastric fistula. Infection of the left ventricular pseudoaneurysm may have precipitated the gastric perforation. This represents an extremely rare late complication of aneurysmectomy procedures and, to our knowledge, is the first case to be reported in the absence of primary gastrointestinal pathology.