Cases reported "Aortic Diseases"

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11/37. Recurrent aortoenteric fistula: case report and review.

    Aortoenteric fistulas (AEFs) are abnormal communications between the aorta and the bowel most frequently resulting from prosthetic graft erosion. Despite advances in surgery and medical technology, these entities are still associated with significant morbidity and mortality for the patient. Multiple case reports and reviews have attempted to elucidate the nature of AEFs in an effort to better characterize and manage these entities. However, reports of recurrence of this process are extremely rare. In this article, we describe a unique case of recurrence of an AEF that was successfully managed with primary aortic oversew and bowel resection. We will also review the literature on AEFs with a comprehensive overview on background, presentation, diagnosis, and current management options.
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12/37. Fatal ascending aorta-to-right ventricle fistula formation after staphylococcus aureus endocarditis of bicuspid aortic valve.

    We present a case of a 46-year-old man with advanced acquired immunodeficiency syndrome and congenitally bicuspid aortic valve endocarditis caused by methicillin- and gentamicin-resistant staphylococcus aureus. endocarditis led to root abscess formation, a complete heart block, and fistulous tract formation between the ascending aorta and the right ventricle. Although perivalvular abscess is not an unusual complication of native valve endocarditis, a fatal fistulous communication between the ascending aorta and the right ventricle is exceedingly rare.
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13/37. Percutaneous closure of an aorta to left atrium fistula with an Amplatzer duct occluder.

    We describe percutaneous closure of an unusual paravalvular leak, with a communication from the noncoronary cusp of the aortic valve to the left atrium adjacent to a St. Jude mitral valve prosthesis, in the absence of an infection. The patient presented with worsening dyspnea and edema. The anatomic location of the valve annulus adjacent to the noncoronary cusp underlies the etiology of this communication. Outcomes from surgical repair are associated with high mortality. We performed percutaneous closure of the defect, using general anesthesia and transesophageal echo guidance. An Amplatzer duct occluder was placed in the fistula, with immediate and complete closure of the shunt. While no devices specific for closure of paravalvular leaks have been designed, growing experience with a variety of devices and the use of echo guidance have allowed successful therapy in many complex cases.
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14/37. Endovascular repair of a bleeding secondary aortoenteric fistula with acute leg ischemia: a case report and review of the literature.

    The endovascular approach seems very attractive for patients with bleeding secondary aortoenteric fistulas (SAEF) and limb ischemia, particularly when there is no associated sepsis. Aortic stent-grafting can rapidly seal the aortoenteric communication and ensure limb reperfusion. In the present case, a 53-year-old man with a bleeding SAEF and acute leg ischemia underwent aortic stent-grafting. Ten months later, CT and leukocyte scan (Tc-99m) showed no evidence of graft infection and the patient remains well 18 months postoperatively. In the typical patient with a bleeding SAEF, endoluminal treatment, if feasible anatomically, should be considered as first-choice treatment whether it represents a "bridging" step or a "definite" solution.
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15/37. Primary aortoduodenal fistula without abdominal aortic aneurysm in association with psoas abscess.

    Primary aortoenteric fistula (PAEF) is a communication between the aorta and the enteric tract without any previous vascular intervention, e.g., aortic grafting. Although rare, PAEF is a potentially lethal condition that requires a high index of suspicion and prompt surgical intervention. Most of the reported cases involve an abdominal aortic aneurysm. However, in this report, we describe a rare case of a primary aortoduodenal fistula in a nonaneurysmal aorta in association with a psoas abscess, which was treated successfully. At 2-year follow-up, the patient is alive without episodes of bleeding or fever.
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16/37. Aortoesophageal fistula due to double aortic arch and prolonged nasogastric intubation: case report and review of the literature.

    BACKGROUND: The authors present a patient and describe other cases from the literature which demonstrate that prolonged use of nasogastric tubes can result in life-threatening aortoesophageal fistula formation in patients with a double aortic arch. CONCLUSION: Aortoesophageal fistula (AEF) is an abnormal communication between the esophagus and the aorta. It can cause massive gastrointestinal hemorrhage. We present an infant with an operatively corrected double aortic arch, who developed this complication after prolonged nasogastric intubation.
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17/37. Homemade endovascular treatment of postoperative aortobronchial fistulas.

    Successful treatments of aortobronchial fistulas were achieved in two cases using a homemade endovascular stent graft. In one, a 75-year-old man was operated on for a distal arch aneurysm 11 years previously. In the other, a 73-year-old woman was operated on for a ruptured type B aortic dissection 2 months previously. In both cases, the chief complaint was repeated hemoptysis, and the communication between the aorta and the airway tract was at the distal anastomotic site in the descending aorta. To minimize risks associated with reoperation, endovascular stent grafting was selected electively. Postoperative courses were uneventful and there were no recurrences of hemoptysis.
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18/37. Ultrasonic and comparative angiographic appearances of a spontaneous aorto-caval fistula.

    A 71-year-old man with an atherosclerotic abdominal aortic aneurysm developed a spontaneous aorto-caval fistula. The ultrasound appearances showing a direct fistulous communication between the inferior vena cava and the aorta are presented and these are correlated with the angiographic appearances.
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19/37. aorta-vena cava fistula.

    In 1831 James Syme described the unusual occurrence of an aortocaval fistula in a 22-year-old man with luetic aortitis. This initial report was followed by illustration of this phenomenon in Rokitanski's Book of Pathologic anatomy in 1841 and by Ryle's delineation of an aortocaval fistula on a pathologic specimen placed in Guy's Hospital Museum in 1892. The first series of aortocaval fistulas, cited by Rudolf Matas in 1909, consisted of a collection of 20 cases gathered by Boinet 10 years earlier. Several later reports, including those by Reid in 1925 and by Lehman in 1938, failed to add any additional cases. It was not until 1955 that Boffi presented an additional six patients who had this disorder, none of whom survived. Since that time, more than 100 cases of spontaneous aortocaval fistulas have been documented. This increasing experience has resulted in improved understanding and surgical treatment of these large-vessel arteriovenous communications. Nevertheless, lack of awareness and failure of recognition of this problem continue to impede its successful management. In this review we present two additional illustrative cases, summarize the clinical and pathophysiologic features of aortocaval fistulas, and outline present approaches to treatment.
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20/37. Congenital fistulous tract between aorta and right atrium presenting as heart failure in a newborn.

    A newborn with a fistulous communication between the right coronary sinus and right atrium had congestive heart failure on the first day of life. Medical management was unsuccessful and operative repair was performed using bypass surgery at 5 days of age. Echocardiographic evaluation preoperatively diagnosed the defect correctly and postoperatively confirmed a complete repair. Since aneurysms and/or fistulae can occur in other sinuses after an initial repair of the presenting lesion, the infant will continue to be followed with periodic echocardiographic and clinical evaluations.
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