| TIME . | EVENT . |
|---|---|
| DAY 0 | A 67-year-old man with a history of mechanic Bentall procedure 19 years before presents to the emergency department with acute respiratory distress. Transthoracic echocardiography shows biventricular moderate dysfunction with a normally functioning mechanical aortic valve. Diuretics and non-invasive ventilation are started. Blood cultures are collected. |
| DAY 1 | The patient is intubated due to persistent severe respiratory failure despite non-invasive ventilation, diuretics, and inotropes. |
| DAY 4 | Transoesophageal echocardiography demonstrates a voluminous pseudoaneurysm of the aortic root and a direct communication between it and the pulmonary artery with a massive left-to-right shunt causing pulmonary hyper flow. Computed tomography angiography shows a supravalvular aortic pseudoaneurysm (max dimension 5 × 3 × 4.6 cm) communicating with the right ventricular outflow tract with the evidence of an aortopulmonary fistula (diameter 10 mm) associated with a left-to-right holosystolic shunt leading to dilated pulmonary arteries and pulmonary hyper flow. Blood cultures are negative. A Heart Team discussion is conducted. |
| DAY 5 | The patient undergoes cardiac surgery, including surgical correction of the aortic pseudoaneurysm with a tubular prosthesis, composite graft and direct reimplantation of the left main coronary artery into an interposition graft (Cabrol graft–left main anastomosis), and heterologous pericardial patch closure of the aortopulmonary fistula. |
| DAY 6 | An improvement in respiratory exchanges is observed, resulting in extubation from the orotracheal tube, along with an improvement in haemodynamic status and the recovery of cardiac function, leading to the weaning from inotropic support. |
| 1 MONTH | The patient is recovering well. |
| TIME . | EVENT . |
|---|---|
| DAY 0 | A 67-year-old man with a history of mechanic Bentall procedure 19 years before presents to the emergency department with acute respiratory distress. Transthoracic echocardiography shows biventricular moderate dysfunction with a normally functioning mechanical aortic valve. Diuretics and non-invasive ventilation are started. Blood cultures are collected. |
| DAY 1 | The patient is intubated due to persistent severe respiratory failure despite non-invasive ventilation, diuretics, and inotropes. |
| DAY 4 | Transoesophageal echocardiography demonstrates a voluminous pseudoaneurysm of the aortic root and a direct communication between it and the pulmonary artery with a massive left-to-right shunt causing pulmonary hyper flow. Computed tomography angiography shows a supravalvular aortic pseudoaneurysm (max dimension 5 × 3 × 4.6 cm) communicating with the right ventricular outflow tract with the evidence of an aortopulmonary fistula (diameter 10 mm) associated with a left-to-right holosystolic shunt leading to dilated pulmonary arteries and pulmonary hyper flow. Blood cultures are negative. A Heart Team discussion is conducted. |
| DAY 5 | The patient undergoes cardiac surgery, including surgical correction of the aortic pseudoaneurysm with a tubular prosthesis, composite graft and direct reimplantation of the left main coronary artery into an interposition graft (Cabrol graft–left main anastomosis), and heterologous pericardial patch closure of the aortopulmonary fistula. |
| DAY 6 | An improvement in respiratory exchanges is observed, resulting in extubation from the orotracheal tube, along with an improvement in haemodynamic status and the recovery of cardiac function, leading to the weaning from inotropic support. |
| 1 MONTH | The patient is recovering well. |
| TIME . | EVENT . |
|---|---|
| DAY 0 | A 67-year-old man with a history of mechanic Bentall procedure 19 years before presents to the emergency department with acute respiratory distress. Transthoracic echocardiography shows biventricular moderate dysfunction with a normally functioning mechanical aortic valve. Diuretics and non-invasive ventilation are started. Blood cultures are collected. |
| DAY 1 | The patient is intubated due to persistent severe respiratory failure despite non-invasive ventilation, diuretics, and inotropes. |
| DAY 4 | Transoesophageal echocardiography demonstrates a voluminous pseudoaneurysm of the aortic root and a direct communication between it and the pulmonary artery with a massive left-to-right shunt causing pulmonary hyper flow. Computed tomography angiography shows a supravalvular aortic pseudoaneurysm (max dimension 5 × 3 × 4.6 cm) communicating with the right ventricular outflow tract with the evidence of an aortopulmonary fistula (diameter 10 mm) associated with a left-to-right holosystolic shunt leading to dilated pulmonary arteries and pulmonary hyper flow. Blood cultures are negative. A Heart Team discussion is conducted. |
| DAY 5 | The patient undergoes cardiac surgery, including surgical correction of the aortic pseudoaneurysm with a tubular prosthesis, composite graft and direct reimplantation of the left main coronary artery into an interposition graft (Cabrol graft–left main anastomosis), and heterologous pericardial patch closure of the aortopulmonary fistula. |
| DAY 6 | An improvement in respiratory exchanges is observed, resulting in extubation from the orotracheal tube, along with an improvement in haemodynamic status and the recovery of cardiac function, leading to the weaning from inotropic support. |
| 1 MONTH | The patient is recovering well. |
| TIME . | EVENT . |
|---|---|
| DAY 0 | A 67-year-old man with a history of mechanic Bentall procedure 19 years before presents to the emergency department with acute respiratory distress. Transthoracic echocardiography shows biventricular moderate dysfunction with a normally functioning mechanical aortic valve. Diuretics and non-invasive ventilation are started. Blood cultures are collected. |
| DAY 1 | The patient is intubated due to persistent severe respiratory failure despite non-invasive ventilation, diuretics, and inotropes. |
| DAY 4 | Transoesophageal echocardiography demonstrates a voluminous pseudoaneurysm of the aortic root and a direct communication between it and the pulmonary artery with a massive left-to-right shunt causing pulmonary hyper flow. Computed tomography angiography shows a supravalvular aortic pseudoaneurysm (max dimension 5 × 3 × 4.6 cm) communicating with the right ventricular outflow tract with the evidence of an aortopulmonary fistula (diameter 10 mm) associated with a left-to-right holosystolic shunt leading to dilated pulmonary arteries and pulmonary hyper flow. Blood cultures are negative. A Heart Team discussion is conducted. |
| DAY 5 | The patient undergoes cardiac surgery, including surgical correction of the aortic pseudoaneurysm with a tubular prosthesis, composite graft and direct reimplantation of the left main coronary artery into an interposition graft (Cabrol graft–left main anastomosis), and heterologous pericardial patch closure of the aortopulmonary fistula. |
| DAY 6 | An improvement in respiratory exchanges is observed, resulting in extubation from the orotracheal tube, along with an improvement in haemodynamic status and the recovery of cardiac function, leading to the weaning from inotropic support. |
| 1 MONTH | The patient is recovering well. |
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