1/218. Cardiocutaneous fistula.infection of the Teflon pledgets on the heart suture line after left ventricular aneurysm repair, presenting late with a fistulous tract connecting the heart with the skin (cardiocutaneous fistula) is an uncommon but potentially serious condition. The case is reported of a 73 year old man who developed a cardiocutaneous fistula extending through the left hemidiaphragm and draining at the abdominal wall, which developed six years after left ventricular aneurysmectomy. Following radiographic evaluation, which established the diagnosis, the Teflon pledgets and fistulous tract were successfully surgically removed. Prompt diagnosis depends on a high index of suspicion. Eradication of infection requires excision of infected material, which must be planned on an individual basis.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
2/218. Aorto-right ventricular fistula: a late complication of aortic valve replacement.We report the case of a patient who was found to have an aorto-right ventricular fistula 17 years after receiving a Bjork-Shiley prosthetic aortic valve. A pseudoaneurysm had formed at the aortotomy suture line, and it had extended into the interventricular septum and had eventually opened into the right ventricle. Using transesophageal echocardiography, we identified the defect in the ascending aorta, and a left-to-right shunt. aortography was used to confirm these findings. The pseudoaneurysm was successfully resected and the ascending aorta was replaced with a Dacron graft. To the best of our knowledge, no similar late complication of aortic valve replacement has been reported in the medical literature.- - - - - - - - - - ranking = 1.9999080776744keywords = aneurysm, pseudoaneurysm (Clic here for more details about this article) |
3/218. aorta-cutaneous fistula as a rare complication of localized chronic mediastinitis.A 35-year-old man was admitted 5 years after congenital heart surgery complicated by staphylococcus aureus and a cutaneous fistula located at the left fourth intercostal space. He was febrile (40 degrees C), suffering from sternal pain and suppuration from the old fistula. During examination arterial blood suddenly discharged from the fistula, so that surgery was immediately instituted. An infected Dacron tube implanting on the ascending aorta for a central aorto-pulmonary shunt was at the origin of a false aneurysm: this had led to the repeat formation of an aorta-cutaneous fistula and outbreak of external bleeding.- - - - - - - - - - ranking = 0.5keywords = aneurysm (Clic here for more details about this article) |
4/218. Urgent aortic valve replacement in disseminated gonococcaemia associated with sinus of valsalva aneurysm and fistula formation.A patient with aortic valve disruption due to gonococcal endocarditis and associated with a sinus of valsalva aneurysm and fistula into the right ventricle is described. The rarity of this combination of conditions and the place of surgery in their management are discussed.- - - - - - - - - - ranking = 2.5keywords = aneurysm (Clic here for more details about this article) |
5/218. Aortoduodenal fistula presenting as acute massive gastrointestinal bleeding and recurrent syncope: case report.Aortoenteric fistula is a rare condition that may cause death in patients due to gastrointestinal bleeding. The duodenum is the most frequently involved site, at 78.5% of 191 cases by Nagy and Marshall's meta-analysis. It is characterized by the clinical triad of abdominal pain, gastrointestinal bleeding, and an abdominal mass. Abdominal computed tomography is the most useful tool in detecting an aortoenteric fistula. To prevent a high mortality rate, early diagnosis is necessary. Exploratory laparotomy is required for patients who are highly suspected of having an aortoduodenal fistula. Herein, we report a 60-year-old man who suffered from acute gastrointestinal bleeding, recurrent syncope, and impending shock. Abdominal computed tomography revealed a 6 cm longitudinal aneurysm in the infrarenal aorta. Emergency laparotomy was performed and revealed an aortoduodenal fistula in the fourth portion of the duodenum causing acute duodenal bleeding. The patient survived and has undergone 2 years worth of regular follow-up in our outpatient department.- - - - - - - - - - ranking = 0.5keywords = aneurysm (Clic here for more details about this article) |
6/218. Palliative treatment of a secondary aortoduodenal fistula by stent-graft placement.A 64-year-old male was admitted with suspected aortoduodenal fistula 16 years after transabdominal aortic reconstruction for aortoiliac occlusive disease. Computed tomography (CT) and angiography revealed an aortoduodenal fistula and a suture-line aneurysm at the proximal anastomosis. Due to the patient's poor general condition at the time of diagnosis, endoluminal stent-graft implantation was chosen rather than conventional surgery. Successful placement of the stent graft without leakage of contrast medium and with complete exclusion of the fistula was demonstrated by CT. The patient recovered uneventfully and was discharged 10 days after the intervention. Five months later contrast CT indicated a recurrence of the aortoduodenal fistula. Since the patient was now in good general condition the stent graft was removed surgically and an extra-anatomic axillofemoral bypass was implanted. Endoluminal stent-graft Implantation is effective as palliative therapy for aortoduodenal fistulas and is especially valuable in patients with high risk for conventional surgery.- - - - - - - - - - ranking = 0.5keywords = aneurysm (Clic here for more details about this article) |
7/218. Aorto-right artrial fistula: a rare complication of aortic dissection.We describe the successful surgical repair of an acute aortic dissection that had caused an aorto-right atrial fistula in a 67-year-old man. The patient was admitted to the hospital on an emergency basis because of severe heart failure. The diagnosis of acute aortic dissection with rupture into the right atrium was confirmed by use of intraoperative transesophageal echocardiography, although rupture of a sinus of valsalva aneurysm into the right atrium had been suggested initially by 2-dimensional and Doppler transthoracic echocardiography. At surgery, we found the patient to have aortic arch dissection with complete separation of the right coronary artery from the sinus of valsalva and a false lumen that had ruptured into the right atrium. The aortic arch was repaired directly. The ascending aorta was successfully replaced with a composite graft. Aortic dissection with rupture into the right atrium is extremely rare and leads to death rapidly. As shown in this case, such a condition might be mistaken for an aneurysmal rupture of the sinus of valsalva, with use of transthoracic echocardiography alone. Transesophageal echocardiography is a useful noninvasive method to further define or confirm the diagnosis. Early surgical intervention is necessary in patients with this condition to prevent profound shock and end-organ failure.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
8/218. Gastrointestinal complications of aortic bypass surgery.Gastrointestinal bleeding following abdominal aortic bypass surgery is not uncommon, as approximately 20% of patients with abdominal aortic aneurysms have peptic ulcer disease. We have recently seen three patients who presented with gastrointestinal bleeding secondary to the complications of their surgery. The cause of the bleeding was aortoduodenal fistula, graft erosion into the sigmoid colon and ischaemic colitis respectively. The correct diagnosis was only considered in one patient, although in retrospect it should have been suggested in all three. Our experiences with these complications and their clinical and radiological presentation form the basis for this paper.- - - - - - - - - - ranking = 0.5keywords = aneurysm (Clic here for more details about this article) |
9/218. Aortocolic fistula, a lethal cause of lower gastrointestinal bleeding: report of a case.Aortocolic fistula occurs with spontaneous rupture of aortic and iliac aneurysms into the sigmoid colon, or due to involvement of the aneurysmal wall by acute diverticulitis. In the eight cases reviewed, this complication proved uniformly lethal, although sufficient clinical findings were present for diagnosis, and adequate time was available for a planned therapeutic approach. Lower gastrointestinal bleeding in the patient who has an aortic aneurysm and left-lower-quadrant inflammation suggests the presence of an aortocolic fistual. angiography should be performed during a bleeding episode to confirm the diagnosis. Surgical correction consists of an axillofemoral by pass graft, excision of the aortic aneurysm, and a Hartmann procedure.- - - - - - - - - - ranking = 2keywords = aneurysm (Clic here for more details about this article) |
10/218. hemoptysis following left ventricular aneurysm repair: a misleading clinical sign.We report on a 66-year-old man with severe hemoptysis following coronary artery bypass grafting and repair of a left ventricular septal defect after acute myocardial infarction. Initial diagnosis was delayed by misleading clinical symptoms and radiologic studies. Due to subfebrile temperature and sputum culture positive for pseudomonas aeruginosa, he had been treated with antibiotics before reoperation. At reoperation, replacement of all foreign material and reconstruction of the ventricular repair with bovine pericardium resulted in reinfection with the same organism despite prolonged antibiotic therapy after 6 months. Removal of the pericardial tissue with direct suture closure of the ventricles and interposition of omentum led to complete healing of the infection without reoccurrence after 2 years.- - - - - - - - - - ranking = 2keywords = aneurysm (Clic here for more details about this article) |
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