Chronic Aortic Dissection with Aorta-Right Atrium Fistula

Abstract

Aortic dissection with rupture into the right atrium is an extremely rare and rapidly fatal condition. We report the case of a 59-year-old man with a history of double valve replacement 2 years earlier at another hospital. Although the previous postoperative course had been uneventful, the patient had experienced facial edema and general fatigue for 10 days before admission to our hospital because of heart failure. The diagnosis of chronic aortic dissection with rupture into the right atrium was confirmed by intraoperative transesophageal echocardiography. At operation, we observed an aortic dissection that originated from a tear in the original aortic incision line. The fistula extended from the false lumen to the right atrium. The aortic adventitia were partially defective. The aortic dissection had ruptured and a pseudo-aneurysm had formed. We performed ascending aortic replacement and closure of the aorta-right atrium fistula under hypothermic arrest on cardiopulmonary bypass. The postoperative course was uneventful and the patient was discharged on the 17th postoperative day.