Aortopulmonary Fistula associated with ruptured aortic arch aneurysm diagnosed by intraoperative transesophageal echocardiography: A Case Report

Abstract

　A 71-year-old woman visited her family doctor with complaints of general malaise and hemoptysis. Computed tomography (CT) showed an impending rupture of an arch aortic aneurysm, and she was transferred to our hospital for surgery. CT showed a large aneurysm of the aortic arch that compressed the left pulmonary artery and left bronchus and a right cardiac overload. The pulmonary artery pressure was above 50 mmHg after anesthesia induction. When the chest was opened, further elevation of pulmonary artery pressure and hypotension were observed, and total cardiopulmonary bypass was initiated. However, the pulmonary artery pressure did not decrease after the initiation of total cardiopulmonary bypass, and it remained at the same level as the arterial pressure. An aortic pulmonary fistula was suspected, and transesophageal echocardiography confirmed the flow from the arch aneurysm to the pulmonary artery. The fistula was detected within the operative field, and it could be weaned from the cardiopulmonary bypass without any problems by direct closure.