A Case of Huge Aortic Arch Aneurysm with Unrevealed Aortopulmonary Fistula Resulting Intraoperative Pulmonary Artery Rupture after Total Arch Replacement

(Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji, Himeji, Japan)

Masato Yoshida Nobuhiko Mukohara Hidefumi Obo
Keitaro Nakagiri Hiroya Minami Tomoki Hanada
Ayako Maruo Hironori Matsuhisa Naoto Morimoto
Tsutomu Shida
A 70-year-old-woman was admmitted to receive an operation for aortic arch aneurysm. Total arch replacement was carried out under deep hypothermic circuratory arrest with selective cerebral perfusion. During sternal closure, her blood pressure dropped to 60/30mmHg suddenly, and massive venous bleeding started from the substernal space which turned out to be hemorrhage from the laceration of the pulmonary trunk. Controlling the bleeding by finger compression, rapid introduction of cardiopulmonary bypass was carried out and the laceration was closed by a pericardial patch. The postoperative course was uneventful. In this case, compression of the pulmonary trunk by the aortic arch aneurysm may have caused the fistula formation between them, and decompression of the aneurysm probably induced the rupture of the pulmonary trunk. If the preoperative computed tomogram had showed the compression of the pulmonary artery by the aneurysm, a careful exploration of the main pulmonary artery and a removal of the thrombus should have been performed, even when the preoperative diagnostic evaluation failed to reveal aortopulmonary fistula.
@Jpn. J. Cardiovasc. Surg. 33: 403-406 (2004)