title: Aorto-atrial fistula associated with recurrent aortic dissection after ascending aorta replacement.
abstract: A 70-year-old woman with a bicuspid aortic valve had undergone ascending aorta replacement for acute DeBakey type I dissection. Computed tomography and aortography 2 months after the operation revealed a thrombosed false lumen in the ascending aorta proximal to the prosthetic graft. However, recurrence of dissection was found at the aortic root proximal to the graft 4 years after the initial operation. Significant aortic stenosis was also noted. Despite intensive medical treatment, she had refractory and progressive heart failure. At the second surgery, an aorto-right atrial fistula, which probably was responsible for the severe heart failure was revealed. Closure of the aorto-right atrial fistula, and aortic root replacement were performed using Piehler's method, with a composite graft. The etiology and management of this rare case are discussed.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Kansai Medical University, Moriguchi, Osaka, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Fujii
authors.forename: T
authors.initials: T
authors.lastname: Oka
authors.forename: H
authors.initials: H
authors.lastname: Kawaguchi
authors.forename: M
authors.initials: M
authors.lastname: Kido
authors.forename: H
authors.initials: H
authors.lastname: Ninomiya
authors.forename: M
authors.initials: M
authors.lastname: Osako
authors.forename: H
authors.initials: H
authors.lastname: Otani
authors.forename: H
authors.initials: H
authors.lastname: Imamura
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D000792:Angiography; D001013:Aorta, Thoracic; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D001672:Biocompatible Materials; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D004452:Echocardiography; D005260:Female; D005402:Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D005500:Follow-Up Studies; D006325:Heart Atria; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D011093:Polyethylene Terephthalates; D011475:Prosthesis Failure; D012008:Recurrence; D012086:Reoperation; D014057:Tomography, X-Ray Computed