Late development of aortic pseudoaneurysm after coarctation repair with fistulization to the bronchial tree. A case report.
BACKGROUND
Fistulous communication between the aorta and the tracheobronchial tree is an uncommon and serious cause of hemoptysis secondary to complications of a previous operation performed on the aorta. In cases in which an appropriate surgical intervention is carried out, the survival rate approaches 76%. This surgery is considered one of the most risky operations on the aorta, challenging the surgeon's ability to resolve the problem.


METHODS
We present the case report of a 43-year-old female with massive hemoptysis. Her medical history disclosed repair of coarctation of the aorta (15 years before). She underwent emergency left thoracotomy; surgical exploration revealed a false aneurysm from the previous aortic patch repair which communicated to a subsegmental bronchus of the left upper lobe.


RESULTS
The thoracic aorta was isolated and clamped, and the previous patch was removed. The bronchial side of the fistula was managed with left superior lobectomy and the aorta was repaired with the placement of a coated woven dacron graft onto healthy aortic tissue.


CONCLUSIONS
The patient had an uneventful recovery and remains asymptomatic six months after discharge.
Instituto Mexicano del Seguro Social, La Herradura, Edo Mex, México, Department of Cardiac Surgery and Circulatory Support, Centro, Médico La Raza, IMSS México, D.F., México.
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Miramontes
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Villaseñor
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Cadena
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Olivares
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Calderón
D000328:Adult; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D001013:Aorta, Thoracic; D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000601:surgery; D001983:Bronchial Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006469:Hemoptysis / Q000175:diagnosis; D006801:Humans; D018570:Risk Assessment; D019616:Thoracic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D013908:Thoracotomy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D014656:Vascular Surgical Procedures / Q000379:methods*