title: [Aortopulmonary fistula caused by aortic arch aneurysm rupture presenting severe left to right shunt and congestive heart failure].
abstract: A 74-year-old female was admitted to our hospital due to hyperkinetic congestive heart failure. Noninvasive positive pressure ventilation, continuous hemodialysis and inotropic support were needed preoperatively. Computed tomography revealed saccular aortic arch aneurysm with aortopulmonary fistula toward the left pulmonary artery. Cardiac catheterization revealed severe left to right shunt with the pulmonary flow/systemic flow (Qp/Qs) ratio of 6.2.Emergency operation was performed under hypothermic circulatory arrest followed by selective cerebral perfusion and lower body perfusion. The aortopulmonary fistula was directly closed, reinforced with the aneurysmal wall, and total arch replacement was performed. Although the patient temporarily recovered by endoscopic suction of the blood from the lungs and continuous hemodialysis filtration, she died because of multiple organ failure due to mesenteric ischemia on postoperative day 34.
authors.affiliation: Second Department of Surgery, Yamagata University, Yamagata, Japan.
authors.forename: Ai
authors.initials: A
authors.lastname: Takahashi
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Uchida
authors.forename: Cholsu
authors.initials: C
authors.lastname: Kim
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Maekawa
authors.forename: Ryota
authors.initials: R
authors.lastname: Miyazaki
authors.forename: Masahiro
authors.initials: M
authors.lastname: Mizumoto
authors.forename: Shuto
authors.initials: S
authors.lastname: Hirooka
authors.forename: Takumi
authors.initials: T
authors.lastname: Yasumoto
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Yoshimura
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Sadahiro
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000150:complications*; D001019:Aortic Rupture / Q000150:complications*; D001159:Arterio-Arterial Fistula / Q000209:etiology* / Q000601:surgery; D005260:Female; D006333:Heart Failure / Q000209:etiology*; D006801:Humans; D011651:Pulmonary Artery / Q000002:abnormalities / Q000601:surgery