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(Circulation. 2009;119:3036-3039.)
© 2009 American Heart Association, Inc.

Images in Cardiovascular Medicine

Aortic Pseudoaneurysm Complicated by Aortopulmonary Fistula

Pilar Jiménez-Quevedo, MD, PhD; José Alberto de Agustín, MD; Rodrigo Fernández-Jiménez, MD; Paloma Aragoncillo, MD, PhD; Carlos Macaya, MD, PhD

From the Instituto Cardiovascular (P.J.-Q., J.A.d.A., R.F.-J., C.M.), and Pathology Department (P.A.), Hospital Clínico San Carlos, Madrid, Spain.

Correspondence to Pilar Jimenez-Quevedo, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid 28040, Spain. E-mail patrop@telefonica.net

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 78-year-old woman presented with an abrupt onset of chest pain and dyspnea. Fourteen years before admission, she had undergone aortic root and valve replacement with the Bentall-de Bono continuous-suture wrap-inclusion technique because of an aneurysm of the ascending aorta and severe aortic valve regurgitation. Physical examination revealed signs of congestive heart failure and poor peripheral perfusion. The admission radiograph (Figure 1) showed lung congestion predominantly in the right lung, bilateral pleural effusion, elevation of the left hemidiaphragm, tracheal shift to the right side, and aortic arch calcification. The ECG (Figure 2) revealed sinus tachycardia at 111 bpm, frequent premature atrial beats, and repolarization abnormalities that consisted of T-wave inversion in the inferolateral leads. Transthoracic echocardiography showed a hypertrophied left ventricle with normal systolic function. Computed tomography disclosed a huge pseudoaneurysm of the ascending aorta (maximum diameter 7 cm) surrounding and compressing the aortic graft (Figure 3); a saccular protrusion of the pseudoaneurysm into the right pulmonary artery was also identified. Transesophageal echocardiography demonstrated systolic collapse of the prosthetic aortic graft (Figure 4A; Movie). In addition, a communication was noted between the pseudoaneurysm and the right pulmonary artery that resulted in a large aortopulmonary shunt (Figure 4B).

View larger version (116K):   Figure 1. Chest radiograph on admission showing alveolar pulmonary edema, bilateral pleural effusion, left hemidiaphragm elevation, and tracheal shift to the right side (arrow).

View larger version (108K):   Figure 2. ECG on admission showing sinus tachycardia, frequent auricular ectopic activity, and T-wave inversion in the inferolateral leads.

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