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Case Report

RMJ. 2010; 35(2): 253-254


Aortobronchial fistula after coarctation repair treated with extra-anatomic graft

Javed Hayat.


Abstract

ABSTRACT
Two cases of aortobronchial fistula are presented which developed several years after successful aortic coarctation repair. These were successfully managed with extra-anatomic conduit graft. (Rawal Med J 2010;35: ).
Keywords
Aortobronchial fistula, coarctation of aorta, hemoptysis.
INTRODUCTION
Aortobronchial fistula (ABF) is a rare postoperative complication of thoracic aortic surgery. Outcome is serious with 100% mortality, if not diagnosed timely and intervention carried out promptly and meticulously.1 Diagnosis should be suspected in patients presenting with hemoptysis who previously had undergone aortic surgery. Once ABF is suspected, patients should have emergent CT or MRI.2 After the diagnosis is established, patient should have either surgical repair or endovascular stenting. Following are the two cases of ABF, who developed this complication several years after successful aortic coarctation repair. Both were treated successfully using an extra-anatomic conduit graft.
CASE 1
A 30 years old woman was admitted with large hemoptysis. It settled spontaneously and rapidly. This happened six years after a diamond patch aortoplasty for her aortic coarctation repair. On physical examination, she had temperature of 39oC. Her blood pressure was 160/70 mm Hg and a regular heart rate of 85/minute. Chest was clinically clear with a soft systolic murmur audible over the left anterior chest. Both femoral pulses were present. Laboratory investigations did not reveal any abnormality. Chest roentgenogram showed a mass adjacent to the aortic knuckle. CT and aortography confirmed the presence of an aneurysm around the aortic coarctation site eroding through the left bronchial tree. There was, however, no recurrent coarctation. Hypertension was controlled with labetalol infusion and and left posterolateral thoracotomy was performed through the 4th intercostal space. Pseudoaneurysm was left untouched. A 24 mm gelatin impregnated polyster graft was selected and a partial occluding clamp was applied on to the ascending aorta and the graft was anastomosed to it end to side. Fistulous communication between the left upper lobe and descending aorta was identified and closed. Repair was covered with mediastinal pleura. Postoperatively, she developed loculated hemothorax with left lower lobe collapse and pyrexia and her white cell count was high. She was returned back to operating room and clots were removed from her left chest, tracheostomy was also performed and she was slowly weaned off the ventilator. Patient was discharged home on day 20.
CASE 2
A 46 years old man, who underwent Dacron onlay graft repair of aortic coarctation 8 years ago, was admitted with hemoptysis. Soon after his coarctation repair he was returned to the operating room for bleeding which proved difficult to control. Whilst able to move his legs after the initial procedure, he became paraplegic following the second operation. He had partial recovery and was eventually dischar

Key words: Aortobronchial fistula, coarctation of aorta, hemoptysis.






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