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Fistula A 68-year-old man with a history of systemic hypertension and chronic renal failure was admitted to our emergency department with chest pain and dyspnea. He had undergone tube graft replacement of the ascending aorta due to an acute type A aortic dissection 10 years previously. On admission he was hypertensive and tachycardic with a continuous murmur at the left upper sternal border. The electrocardiogram revealed nonspecific repolarization abnormalities and the transthoracic echocardiogram showed a severely dilated aortic root with an intimal flap and continuous turbulent flow from the aortic root toward the right ventricle (Figures 1 and 2). There was moderate aortic regurgitation caused by poor leaflet coaptation. The right chambers were slightly dilated and both ventricles had normal systolic function. Chest computed tomography confirmed aortic root dissection with a fistula between the aortic false lumen and right ventricle (Figures 3 and 4). The coronary arteries were

Acute aortic dissection complicated by aorto-right ventricular fistula