Iatrogenic Aortopulmonary Window and Pulmonary Artery Dissection Secondary to Aortic Cannulation

We present a case of a 23-year-old man with Shone’s complex, including bicuspid aortic valve, coarctation of the aorta status post neonatal repair and subsequent stent placement, mitral valve stenosis status post valve repair, and eventual replacement 1 year before the current presentation. A noncontrast thoracic computed tomography scan was performed after his mitral valve replacement to investigate a persistent pleural effusion. The scan revealed an unusual area of high and low attenuation within the proximal pulmonary arterial system, and a contrast-enhanced computed tomography study was recommended for additional evaluation. However, given that the patient was asymptomatic with unremarkable physical examination, follow-up study was not performed until ≈1 year later when he was noted with a new continuous murmur on physical examination and an echocardiogram revealed continuous flow arising from the distal ascending aorta into the pulmonary artery on two-dimensional color Doppler (Figures 1A …