Successful Surgical Management of an Aortic Arch Aneurysm with an Aorto-Pulmonary Artery Fistula

(First Department of Surgery, Yamaguchi University School of Medicine, Ube, Japan and Miyamoto Clinic*, Kudamatsu, Japan)

Kazuhiro Suzuki Kimikazu Hamano Sayaka Hanada
Masanori Hayashi Bunngo Shirasawa Hiroshi Itou
Akihito Mikamo Masaki Miyamoto*
A 72-year-old woman had undergone resection and graft replacement of the proximal ascending aorta for a DeBakey type II aortic dissection. She presented again 7 years later with progressive dyspnea and a cough. Computed tomography confirmed an aortic arch aneurysm and Doppler echocardiography demonstrated aortopulmonary shunting. Cardiac catheterization revealed a fistula between the aorta and pulmonary artery with a 54.3% left-to-right shunt and a Qp/Qs of 2.19. Operative repair was performed under profound hypothermic circulatory arrest with selective cerebral perfusion. The aortopulmonary artery fistula was closed from within the aneurysm using an equine pericardial patch and the transverse aortic arch was resected and replaced with a graft. The patient recovered uneventfully and was discharged on postoperative day 43.
@Jpn. J. Cardiovasc. Surg. 32F137 -140 (2003)