Acquired aortopulmonary fistula: a case report
Osama Mahmoud1, Hadi Elias1, Arsalan Rafiq1
1Department of Cardiology, Geisinger Medical Center, 100 N. Academy Ave. Danville, PA 17821, USA.
European Heart Journal. Case Reports
|September 25, 2020
Summary
A rare aortopulmonary fistula presented insidiously with heart failure. Multimodality cardiac imaging was crucial for diagnosing this ascending aortic aneurysm complication, enabling successful surgical repair.
Area of Science:
- Cardiovascular Surgery
- Diagnostic Imaging
- Aortic Pathology
Background:
- Aortopulmonary fistula is a rare complication of ascending aorta diseases.
- Typical presentations involve acute chest pain or heart failure due to left-to-right shunting.
- This case highlights an unusual, insidious onset of heart failure.
Observation:
- A 79-year-old male with prior cardiac surgery presented with 7 months of exertional dyspnea.
- Initial echocardiography and angiography missed an aortopulmonary fistula secondary to an ascending aortic pseudoaneurysm.
- Diagnosis was achieved through off-axis transthoracic echocardiography and confirmed with multimodality imaging.
Findings:
- An acquired aortopulmonary fistula was identified, stemming from an ascending aortic aneurysm eroding into the pulmonary artery.
- Multimodality imaging, including transesophageal echocardiography and cardiac CT, defined the pathology.
- The patient underwent successful surgical repair and recovered well.
Implications:
- This case underscores the importance of a high index of suspicion for rare conditions like aortopulmonary fistula.
- Multimodality cardiac imaging is essential for diagnosing complex aortopulmonary fistulas with atypical presentations.
- Timely diagnosis and surgical intervention are critical for favorable outcomes in patients with aortopulmonary fistulas.
