title: Two- and three-dimensional transthoracic echocardiography in the assessment of aortic arch vasum vasi to pulmonary artery fistula.
abstract: We report an elderly patient presenting with a stroke and also hemolytic anemia secondary to mitral and tricuspid valve repair 3 years earlier, in whom two-dimensional transesophageal echocardiography (2DTEE) suspected a fistula into the pulmonary artery (APAF) from the posterior wall of the aortic arch. For further assessment, two-dimensional transthoracic echocardiography (2DTTE) and live/real time three-dimensional transthoracic echocardiography (3DTTE) were performed. 2DTTE showed findings similar to 2DTEE. Color Doppler guided continuous-wave Doppler showed continuous flow throughout the cardiac cycle with systolic preponderance across the fistula with a small peak pressure gradient of 22 mmHg. Sequential systematic cropping of the 3D datasets obtained from 3DTTE confirmed that the flow signals originated from the posterior wall of the aortic arch and not the lumen. Thus, 3DTTE served to increase the confidence level that the fistula most likely originated from a vasum vasi in the wall of the aortic arch. To our knowledge, this type of fistula has not been reported previously. Fistulas from the aortic lumen to the pulmonary artery are also rare and so far only 24 cases have been reported in the literature. These are also reviewed by us.
authors.affiliation: University of Alabama, Birmingham, AL, USA.
authors.forename: Kamel
authors.initials: K
authors.lastname: Sadat
authors.forename: Manish
authors.initials: M
authors.lastname: Pradhan
authors.forename: Navin C
authors.initials: NC
authors.lastname: Nanda
authors.forename: Deepak
authors.initials: D
authors.lastname: Joshi
authors.forename: Hari Prakash
authors.initials: HP
authors.lastname: Diddi
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology; D001018:Aortic Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001783:Blood Flow Velocity; D003937:Diagnosis, Differential; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D006801:Humans; D008297:Male; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology