https://orcid.org/0000-0003-4412-6329
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Yankai Mao, Jiwen Li, Jie Han, A rare aortic pseudoaneurysm-right atrial fistula, European Heart Journal, Volume 46, Issue 15, 14 April 2025, Page 1452, https://doi.org/10.1093/eurheartj/ehae860
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Extract
A 50-year-old man, with a history of aortic valve replacement 27 years ago, was presented to the emergency department due to chest pain and dyspnoea. He became haemodynamically unstable after admission, and norepinephrine was administered (0.28 µg/kg/min) to maintain the blood pressure at 101/56 mmHg. Laboratory examination indicated hepatic and renal dysfunction. Computed tomography (CT) and 3D reconstruction revealed a 70 * 60 mm pseudoaneurysm on the right side of the aortic root (Panels A and B, asterisk), with suspected contrast communication with the right atrium (RA) (Panel C, arrow). No pericardial or pleural effusion was present. A diagnosis of acute congestive heart failure due to a fistula formation between the pseudoaneurysm and RA was made, and the patient underwent reoperation several hours later. Intra-operative transoesophageal echocardiography demonstrated the discontinuity of the aortic wall (Panel D, arrow) with a thicken-walled aneurysm to its right (asterisk). The superior vena cava was compressed. Colour Doppler confirmed the formation of a fistula by showing continuous shunt flow between the pseudoaneurysm and RA (Panel E, arrow; Supplementary data online, Video S1). A 10 mm break in the aortic root and a 50 * 20 mm aperture between the pseudoaneurysm and RA were detected and repaired in the surgery (Panels F and G, arrow). Postoperative CT showed no evidence of contrast extravasation in the mediastinum or pericardium, or communication with the RA (Panels H–J). The patient had an uneventful recovery before being discharged 2 weeks later.
