False aneurysm of the ascending aorta with fistula to the right atrium. Noninvasive diagnosis by computed tomographic scan and two-dimensional echocardiography with successful repair.
A 57-year-old Japanese man presented with symptoms of congestive heart failure 9 years after aortic valve replacement. On auscultation, a continuous murmur was heard at the left lower sternal border. Chest radiograph showed moderate cardiomegaly and a widened upper mediastinum. Computed tomographic scans showed a dilated ascending aorta, in which there was no intimal flap, and also showed a large mass which compressed the right atrium. Two-dimensional Doppler echocardiography revealed abnormal continuous blood flow directed from the dilated ascending aorta to the right atrium and no periprosthetic leak. At operation, a false aneurysm of the ascending aorta which originated from the aortotomy suture line and a fistula from the aorta to the right atrium were confirmed. The fistula was closed with pledgeted sutures, and the ascending aorta was replaced with a collagen-coated double woven velour dacron graft. The patient recovered uneventfully. Computed tomographic scan and two-dimensional echocardiography are complementary techniques for reliable non-invasive assessment of the complexity of an aortic aneurysm.
Aoyagi
S
S
Second Department of Surgery, Kurume University School of Medicine, Japan.
Akashi
H
H
Kawara
T
T
Oryoji
A
A
Kosuga
K
K
Oishi
K
K
Fujisawa
M
M
Yamamoto
K
K
D017541:Aneurysm, False / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D001014:Aortic Aneurysm / Q000175:diagnosis* / Q000601:surgery; D001018:Aortic Diseases / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D001021:Aortic Valve; D001807:Blood Vessel Prosthesis; D004452:Echocardiography; D005402:Fistula / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006325:Heart Atria; D006331:Heart Diseases / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D014057:Tomography, X-Ray Computed