False Aneurysm of the Ascending Aorta with Fistula to the Right Atrium

Summary A 57-year-old Japanese man presented with symptoms of congestive heart failure 9 years after aortic valve replacement. On auscultation, a continuous murmur was heard at the left lower sternal border. Chest radiograph showod moderate cardiomegaly and a widened upper mediastinum. Computed tomographic scans showed a dilatod ascending aorta, in which there was no intimal flap, and also showed a large mass which compressed tho right atrium. Two-dimensional Doppler echocardiography revealed abnormal continuous blood flow directed from the dilated ascending aorta to the right atrium and no periprosthetic leak. At operation, a false aneurysm of the ascending aorta which originatod from the aortotomy suture line and a fistula from the aorta to the right atrium were confirmed. The fistula was closed with pledgeted sutures, and the ascending aorta was replaced with a collagen-coated double woven velour dacron graft. The patient recovered uneventfully. Computed tomographic scan and two-dimensional echocardiography are complementary techniques for reliable noninvasive assessment of the complexity of an aortic aneurysm.