title: 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.
abstract: 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.
authors.affiliation: Second Department of Surgery, Kurume University School of Medicine, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Aoyagi
authors.forename: H
authors.initials: H
authors.lastname: Akashi
authors.forename: T
authors.initials: T
authors.lastname: Kawara
authors.forename: A
authors.initials: A
authors.lastname: Oryoji
authors.forename: K
authors.initials: K
authors.lastname: Kosuga
authors.forename: K
authors.initials: K
authors.lastname: Oishi
authors.forename: M
authors.initials: M
authors.lastname: Fujisawa
authors.forename: K
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: 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