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Aortopulmonary Artery Fistula: Ruptured Aneurysm of the Distal Aortic Arch into the Pulmonary Artery
Author(s) -
Sasaki Osamu,
Nishioka Toshihiko,
Inoue Yoshiro,
Sasaki Hideki,
Ito Hiroyuki,
Yoshimoto Nobuo
Publication year - 2013
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12092
Subject(s) - medicine , aortic arch , cardiology , aneurysm , ventricle , aortography , fistula , shunt (medical) , pulmonary artery , aorta , radiology , aortic dissection
Aortopulmonary artery fistula is uncommon, but the clinical outcome is often lethal. A 76‐year‐old man with a history of acute thoracic aortic dissection 6 years previously was admitted with dyspnea. A chest x‐ray showed pleural effusion and pulmonary congestion. Transthoracic echocardiography revealed preserved systolic function, but continuous and abnormal flow from the distal aortic arch into the pulmonary artery ( PA ). Transesophageal echocardiography ( TEE ) in the Doppler color‐flow mode demonstrated a left‐to‐right shunt between a large distal aortic arch aneurysm and the left PA via an aortopulmonary fistula and a pressure gradient across the shunt of 56 mmHg. Contrast‐enhanced computed tomography showed that the aneurysm compressed the PA . Aortography also revealed a large distal aortic arch aneurysm and almost simultaneous contrast enhancement of the aorta and the PA . Right‐heart catheterization showed a significant increase in oxygen saturation between the right ventricle and the PA . A left‐to‐right shunt due to a distal aortic arch aneurysm rupturing into the left PA was diagnosed based on these findings. TEE was very helpful in confirming the presence and precise location of the fistula.

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