Aortopulmonary fistula: Difference between revisions

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==Pathophysiology and Etiology==
==Pathophysiology and Etiology==
Aortopulmonary fistula usually occurs when there is damage to the wall of aorta or pulmonary artery which causes a communication between these two adjacent anatomic structures. Most of the time it happpns in an event of aortic dissection, aortic aneurysm, any surgery that causes damage to wall of aorta or pulmonary artery, pulmonary hypertension and extremely high flow through aorta or pulmonary artery. This can also occur if walls of aorta are fragile as they can be in an event of atheroseclersosis, aortitis and Marfan's syndrome,  The fistula leads to rapid left to right shunting and can have severe consequences. This causes the oxygen saturation of the blood to fall and it can present with signs and symptoms of congestive heart failure and pulmonary edema
== Risk Factors ==
Some of the risk factors for aortopulmonary fistula are given below
* Complication of surgery or thoracic aortic graft <ref>Jones J: Complications of the surgery of patent ductus arteriosus. J Thorac Surg 1947; 16:305-313</ref>  
* Complication of surgery or thoracic aortic graft <ref>Jones J: Complications of the surgery of patent ductus arteriosus. J Thorac Surg 1947; 16:305-313</ref>  
* Indwelling chest tube, spinal fixation device, or foreign body
* Indwelling chest tube, spinal fixation device, or foreign body
* Congenital <ref>{{Cite web|url=https://www.internationaljournalofcardiology.com/article/S0167-5273(14)01251-0/fulltext|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
* Congenital <ref>{{Cite web|url=https://www.internationaljournalofcardiology.com/article/S0167-5273(14)01251-0/fulltext|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
* Repair of coarctation of aorta<ref>{{Cite web|url=https://www.scholars.northwestern.edu/en/publications/aortopulmonary-fistula-in-an-infected-dacron-graft-for-coarctatio|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
*Use of Dacron draft for aortic repair surgery. Elective thoracic endovascular aortic repair is comparatively a safer option. <ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pubmed/28795035|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
*Bentall Operation <ref>{{Cite web|url=https://www.academia.edu/36458364/Acquired_aortopulmonary_fistula_in_pseudoaneurysm_of_the_aorta_six_years_after_a_bentall_operation|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
*Marfan's Syndrome
*Atheroseclerotic inflammation
*Hypertension<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pubmed/27527829|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
*Blunt chest trauma
*Transcatheter pulmonary valve placement
*Ross procedure <ref>{{Cite web|url=https://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.113.000654?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
*pulmonary angioplasty<ref>{{Cite web|url=http://www.revespcardiol.org/en/percutaneous-closure-of-iatrogenic-aortopulmonary/articulo/90273733/|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
*Truncus arteriosus repair<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pubmed/25193221|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
*Atrial Switch Operation<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pubmed/26719412|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
*High output heart failure<ref>{{Cite web|url=https://www.sciencedirect.com/science/article/abs/pii/S1561881117300901|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
*Neoplasm<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4158173/|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
* Erosion and/or rupture of a degenerative or false aneurysm of the distal aortic arch or descending thoracic aorta into the lung. Possible reasons of true or false aneurysms;
* Erosion and/or rupture of a degenerative or false aneurysm of the distal aortic arch or descending thoracic aorta into the lung. Possible reasons of true or false aneurysms;
:*True [[aneurysm]] <ref>Coblentz C, Sallee D, Chiles C: Aortobronchopulmonary fistula complicating aortic aneurysm: diagnosis in four cases. AJR 1988; 150:535-538</ref>
:*True [[aneurysm]] <ref>Coblentz C, Sallee D, Chiles C: Aortobronchopulmonary fistula complicating aortic aneurysm: diagnosis in four cases. AJR 1988; 150:535-538</ref>
Line 20: Line 38:
:*[[Aortic dissection]] <ref>Fernandez Gonzales A, Montero J, Luna D, et al: Aortobronchial fistula secondary to chronic post-traumatic thoracic aneurysm. Tex Heart Inst J 1996; 23:174-177</ref>
:*[[Aortic dissection]] <ref>Fernandez Gonzales A, Montero J, Luna D, et al: Aortobronchial fistula secondary to chronic post-traumatic thoracic aneurysm. Tex Heart Inst J 1996; 23:174-177</ref>
:*Traumatic aortic tear <ref>Szolar D, Riepl T, Stiskal M, et al: Aortobronchial fistula as a late complication of posttraumatic chronic aortic aneurysm. AJR 1995; 164: 1511-1513 </ref>
:*Traumatic aortic tear <ref>Szolar D, Riepl T, Stiskal M, et al: Aortobronchial fistula as a late complication of posttraumatic chronic aortic aneurysm. AJR 1995; 164: 1511-1513 </ref>
:*Aortic suture line breakdown    
:*Aortic suture line breakdow    
:
:Some other risk factors for aortopulmonary fistula are given below.
:*Repair of coarctation of aorta<ref>{{Cite web|url=https://www.scholars.northwestern.edu/en/publications/aortopulmonary-fistula-in-an-infected-dacron-graft-for-coarctatio|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
:*Use of Dacron draft for aortic repair surgery. Elective thoracic endovascular aortic repair is comparatively a safer option. <ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pubmed/28795035|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
:*Bentall Operation <ref>{{Cite web|url=https://www.academia.edu/36458364/Acquired_aortopulmonary_fistula_in_pseudoaneurysm_of_the_aorta_six_years_after_a_bentall_operation|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
:*Marfan's Syndrome
:*Atheroseclerotic inflammation
:*Hypertension<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pubmed/27527829|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
:*Blunt chest trauma
:*Transcatheter pulmonary valve placement
:*Ross procedure <ref>{{Cite web|url=https://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.113.000654?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
:*pulmonary angioplasty<ref>{{Cite web|url=http://www.revespcardiol.org/en/percutaneous-closure-of-iatrogenic-aortopulmonary/articulo/90273733/|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
:*Truncus arteriosus repair<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pubmed/25193221|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>


==Diagnosis==
==Signs And Symptoms==


===Signs And Symptoms===
The most frequent symptoms of an aortopulmonary fistula are [[chest pain]] and [[hemoptysis]], but often [[shortness of breath]], [[fever]], and/or other respiratory symptoms are present.<ref>MacIntosh E, Parrott J, Unruh H: Fistulas between the aorta and tracheobronchial tree. Ann Thorac Surg 1991; 51:515-519</ref> <ref>Favre J, Gournier J, Adham M, et al: Aortobronchial fistula: report of three cases and review of the literature. Surgery 1994; 115:264-270</ref>. It can also presents with dyspnea, orthopnea, chest discomfort on exertion, dizziness, cool extremities, edema, hypothermic circulatory arrest, right ventricular dysfunction and other symptoms of congestive heart failure.<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763467/|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> Sudden lipothymia and anemia can also indicate aortopulmonary fistula.<ref>{{Cite web|url=http://www.revespcardiol.org/en/acute-clinical-presentation-of-pseudoaneurysm/articulo/90460465/|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> A person can have bounding pulse, prominent precordium, palpable thrill and murmur. There could be crackles and ronchi heard on auscultating lungs.


The most frequent symptoms of an aortopulmonary fistula are [[chest pain]] and [[hemoptysis]], but often [[shortness of breath]], [[fever]], and/or other respiratory symptoms are present.<ref>MacIntosh E, Parrott J, Unruh H: Fistulas between the aorta and tracheobronchial tree. Ann Thorac Surg 1991; 51:515-519</ref> <ref>Favre J, Gournier J, Adham M, et al: Aortobronchial fistula: report of three cases and review of the literature. Surgery 1994; 115:264-270</ref>. It can also presents with dyspnea, orthopnea, chest discomfort on exertion, dizziness, cool extremities, edema, hypothermic circulatory arrest, right ventricular dysfunction and other symptoms of congestive heart failure.<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763467/|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> Sudden lipothymia and anemia can also indicate aortopulmonary fistula.<ref>{{Cite web|url=http://www.revespcardiol.org/en/acute-clinical-presentation-of-pseudoaneurysm/articulo/90460465/|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> A person can have bounding pulse, prominent precordium, palpable thrill and murmur. There could be crackles and ronchi heard on auscultating lungs.
== Post Operation Care ==
In repair of aortopulmonary fistula, patient should be rigorously followed and an eye should be kept on his cardiac health. Few patients who went through aortopulmonary fistula repair showed signs of calss one heart failure with in one year of post operation course.<ref>{{Cite web|url=https://casereports.bmj.com/content/2014/bcr-2014-207374|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> During any aortic surgical repair, use of prosthesis should be avoided because it can lead to greater chances of recurrent infection. Use of pulmonary allograft should also be made available and should be implanted when necessary.<ref>{{Cite web|url=https://www.jtcvs.org/article/S0022-5223(03)00128-4/fulltext|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
 
== Complications ==
Aortopulmonary fistula can be very lethal. Mediastinitis can be one of the complication if recurrent infection occur after surgical repair.<ref>{{Cite web|url=https://www.jtcvs.org/article/S0022-5223(03)00128-4/fulltext|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> Sudden death can occur if immediate surgical intervention is not made at an appropriate time. The risk factors associated with early death after surgical repair are: old age, congestive cardiac insufficiency, angina, dissection, aortic arch management and co-morbidities. Factors like chronic obstructive pulmonary disease, systemic arterial hypertension and peripheral vascular insufficiency in addition to coronary artery insufficiency can also dictate the course of disease.<ref>{{Cite web|url=http://www.bjcvs.org/article/1049/Aneurisma-do-arco-aortico-com-fIstula-aorto-pulmonar--tratamento-cirurgico-com-sucesso|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
 
== Diagnosis ==


===Chest x-ray===
===Chest x-rayp===


[[Chest x-ray]]s help to confirm pulmonary infiltrates. It can show widened mediastinum with pulmonary plethora.
[[Chest x-ray]]s help to confirm pulmonary infiltrates. It can show widened mediastinum with pulmonary plethora.
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</div>
</div>


==Bronchoscopy==
===Bronchoscopy===


Bronchoscopy during an episode of hemoptysis can document its lobar origin.
Bronchoscopy during an episode of hemoptysis can document its lobar origin.
Line 75: Line 86:
Once the diagnosis is confirmed, prompt surgical or percutaneous interventions are indicated.
Once the diagnosis is confirmed, prompt surgical or percutaneous interventions are indicated.


The main focus of treatment should be to control the right to left shunting, resolve the edema in lungs and minimize the signs of heart failure. Immediate surgery is required to meet all these goals. Various surgical otions are on table to choose from and it can vary from one individual to another.
*Endovascular stenting <ref>Miyata T, Ohara N, Shigematsu H, et al: Endovascular stent graft repair of aortopulmonary fistula. J Vasc Surg 1999; 29:557-560</ref> <ref>Campagna A, Wehner J, Kirsch C, et al: Endovascular stenting of an aortopulmonary fistula presenting with hemoptysis. J Cardiovasc Surg 1996; 37:643-646</ref>
*Endovascular stenting <ref>Miyata T, Ohara N, Shigematsu H, et al: Endovascular stent graft repair of aortopulmonary fistula. J Vasc Surg 1999; 29:557-560</ref> <ref>Campagna A, Wehner J, Kirsch C, et al: Endovascular stenting of an aortopulmonary fistula presenting with hemoptysis. J Cardiovasc Surg 1996; 37:643-646</ref>
*Surgery <ref>Lawrence W, Kern J, Tribble C: Repair of aortobronchial fistula using extraanatomic grafts and hypothermic arrest. Ann Thorac Surg 1997; 63:1158-1160</ref>
*Surgery <ref>Lawrence W, Kern J, Tribble C: Repair of aortobronchial fistula using extraanatomic grafts and hypothermic arrest. Ann Thorac Surg 1997; 63:1158-1160</ref>
Line 81: Line 93:
*Conventional elephant trunk implantation<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pubmed/29939255|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
*Conventional elephant trunk implantation<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pubmed/29939255|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
*pericardial patc closure and tube graft<ref>{{Cite web|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/jocs.12212|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
*pericardial patc closure and tube graft<ref>{{Cite web|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/jocs.12212|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
*percutaneous closure with an atrial septal occlusion devise<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pubmed/27440801|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
*Endovascular occlusion devise<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pubmed/27151885|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
Other options which are still under trial includes
Other options which are still under trial includes
*Amplatzer occlude via percutaneous catheterization<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pubmed/27449901|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
*Amplatzer occlude via percutaneous catheterization<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pubmed/27449901|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]


Overview

Aortopulmonary fistula is a connection between aorta and main pulmonary artery.[1] It is a rare but has been thought to be uniformly fatal if not treated surgically. In the earlier experiences with this entity, a chronic infectious process arising in the lung (pneumonitis or abcess or aorta (mycotic aneurysm [2] was the most frequent cause. In recent decades, the reported aortopulmonary fistulas have occurred most frequently as the result of erosion and/or rupture of a degenerative or false aneurysm of the distal aortic arch or descending thoracic aorta into the left lung.[3] [4] [5] [6] [7] [8]

Pathophysiology and Etiology

Aortopulmonary fistula usually occurs when there is damage to the wall of aorta or pulmonary artery which causes a communication between these two adjacent anatomic structures. Most of the time it happpns in an event of aortic dissection, aortic aneurysm, any surgery that causes damage to wall of aorta or pulmonary artery, pulmonary hypertension and extremely high flow through aorta or pulmonary artery. This can also occur if walls of aorta are fragile as they can be in an event of atheroseclersosis, aortitis and Marfan's syndrome, The fistula leads to rapid left to right shunting and can have severe consequences. This causes the oxygen saturation of the blood to fall and it can present with signs and symptoms of congestive heart failure and pulmonary edema

Risk Factors

Some of the risk factors for aortopulmonary fistula are given below

  • Complication of surgery or thoracic aortic graft [9]
  • Indwelling chest tube, spinal fixation device, or foreign body
  • Congenital [10]
  • Repair of coarctation of aorta[11]
  • Use of Dacron draft for aortic repair surgery. Elective thoracic endovascular aortic repair is comparatively a safer option. [12]
  • Bentall Operation [13]
  • Marfan's Syndrome
  • Atheroseclerotic inflammation
  • Hypertension[14]
  • Blunt chest trauma
  • Transcatheter pulmonary valve placement
  • Ross procedure [15]
  • pulmonary angioplasty[16]
  • Truncus arteriosus repair[17]
  • Atrial Switch Operation[18]
  • High output heart failure[19]
  • Neoplasm[20]
  • Erosion and/or rupture of a degenerative or false aneurysm of the distal aortic arch or descending thoracic aorta into the lung. Possible reasons of true or false aneurysms;

Signs And Symptoms

The most frequent symptoms of an aortopulmonary fistula are chest pain and hemoptysis, but often shortness of breath, fever, and/or other respiratory symptoms are present.[25] [26]. It can also presents with dyspnea, orthopnea, chest discomfort on exertion, dizziness, cool extremities, edema, hypothermic circulatory arrest, right ventricular dysfunction and other symptoms of congestive heart failure.[27] Sudden lipothymia and anemia can also indicate aortopulmonary fistula.[28] A person can have bounding pulse, prominent precordium, palpable thrill and murmur. There could be crackles and ronchi heard on auscultating lungs.

Post Operation Care

In repair of aortopulmonary fistula, patient should be rigorously followed and an eye should be kept on his cardiac health. Few patients who went through aortopulmonary fistula repair showed signs of calss one heart failure with in one year of post operation course.[29] During any aortic surgical repair, use of prosthesis should be avoided because it can lead to greater chances of recurrent infection. Use of pulmonary allograft should also be made available and should be implanted when necessary.[30]

Complications

Aortopulmonary fistula can be very lethal. Mediastinitis can be one of the complication if recurrent infection occur after surgical repair.[31] Sudden death can occur if immediate surgical intervention is not made at an appropriate time. The risk factors associated with early death after surgical repair are: old age, congestive cardiac insufficiency, angina, dissection, aortic arch management and co-morbidities. Factors like chronic obstructive pulmonary disease, systemic arterial hypertension and peripheral vascular insufficiency in addition to coronary artery insufficiency can also dictate the course of disease.[32]

Diagnosis

Chest x-rayp

Chest x-rays help to confirm pulmonary infiltrates. It can show widened mediastinum with pulmonary plethora.

Echocardiogram

Echo can show dilation of aorta and increased flow of pulmonary artery.

Cardiac Catheterization

Cardiac catheterization can show elevated pressure in pulmonary artery. The pressures can be as high as that of aorta.

Aortogram

It can show dilation of aorta and the fistulous communication between aorta and main pulmonary artery.

CT

Bronchoscopy

Bronchoscopy during an episode of hemoptysis can document its lobar origin.

Aortography

Aortography is a gold standard of diagnosing of aortopulmonary fistula. Subtraction technique may help to obtain additional information.

Treatment

Once the diagnosis is confirmed, prompt surgical or percutaneous interventions are indicated.

The main focus of treatment should be to control the right to left shunting, resolve the edema in lungs and minimize the signs of heart failure. Immediate surgery is required to meet all these goals. Various surgical otions are on table to choose from and it can vary from one individual to another.

  • Endovascular stenting [33] [34]
  • Surgery [35]
  • percutaneous amplatzer septal occluder [36]
  • Amplatzer occulder using antegrade venous approach might decrease the risk of subsequent cardiac surgery as well.[37]
  • Conventional elephant trunk implantation[38]
  • pericardial patc closure and tube graft[39]
  • percutaneous closure with an atrial septal occlusion devise[40]
  • Endovascular occlusion devise[41]

Other options which are still under trial includes

  • Amplatzer occlude via percutaneous catheterization[42]
  • pulmonary artery catheterization with thoracotomy

References

  1. ↑ https://www.rightdiagnosis.com/medical/aortopulmonary_fistula.htm. Missing or empty |title= (help)
  2. ↑ https://www.medscape.com/viewarticle/410487. Missing or empty |title= (help)
  3. ↑ Killen D.A, Aortopulmonary Fistula, South Med J 93(2), 2000
  4. ↑ MacIntosh E, Parrott J, Unruh H: Fistulas between the aorta and tracheobronchial tree. Ann Thorac Surg 1991; 51:515-519
  5. ↑ Fernandez Gonzales A, Montero J, Luna D, et al: Aortobronchial fistula secondary to chronic post-traumatic thoracic aneurysm. Tex Heart Inst J 1996; 23:174-177
  6. ↑ DeProphetis N, Armitage H, Triboletti E: Rupture of tuberculous aortic aneurysm into lung. Ann Surg 1959; 150:1046-1051
  7. ↑ Favre J, Gournier J, Adham M, et al: Aortobronchial fistula: report of three cases and review of the literature. Surgery 1994; 115:264-270
  8. ↑ Szolar D, Riepl T, Stiskal M, et al: Aortobronchial fistula as a late complication of post traumatic chronic aortic aneurysm. AJR 1995; 164:1511-1513
  9. ↑ Jones J: Complications of the surgery of patent ductus arteriosus. J Thorac Surg 1947; 16:305-313
  10. ↑ https://www.internationaljournalofcardiology.com/article/S0167-5273(14)01251-0/fulltext. Missing or empty |title= (help)
  11. ↑ https://www.scholars.northwestern.edu/en/publications/aortopulmonary-fistula-in-an-infected-dacron-graft-for-coarctatio. Missing or empty |title= (help)
  12. ↑ https://www.ncbi.nlm.nih.gov/pubmed/28795035. Missing or empty |title= (help)
  13. ↑ https://www.academia.edu/36458364/Acquired_aortopulmonary_fistula_in_pseudoaneurysm_of_the_aorta_six_years_after_a_bentall_operation. Missing or empty |title= (help)
  14. ↑ https://www.ncbi.nlm.nih.gov/pubmed/27527829. Missing or empty |title= (help)
  15. ↑ https://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.113.000654?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed. Missing or empty |title= (help)
  16. ↑ http://www.revespcardiol.org/en/percutaneous-closure-of-iatrogenic-aortopulmonary/articulo/90273733/. Missing or empty |title= (help)
  17. ↑ https://www.ncbi.nlm.nih.gov/pubmed/25193221. Missing or empty |title= (help)
  18. ↑ https://www.ncbi.nlm.nih.gov/pubmed/26719412. Missing or empty |title= (help)
  19. ↑ https://www.sciencedirect.com/science/article/abs/pii/S1561881117300901. Missing or empty |title= (help)
  20. ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4158173/. Missing or empty |title= (help)
  21. ↑ Coblentz C, Sallee D, Chiles C: Aortobronchopulmonary fistula complicating aortic aneurysm: diagnosis in four cases. AJR 1988; 150:535-538
  22. ↑ DeProphetis N, Armitage H, Triboletti E: Rupture of tuberculous aortic aneurysm into lung. Ann Surg 1959; 150:1046-1051
  23. ↑ Fernandez Gonzales A, Montero J, Luna D, et al: Aortobronchial fistula secondary to chronic post-traumatic thoracic aneurysm. Tex Heart Inst J 1996; 23:174-177
  24. ↑ Szolar D, Riepl T, Stiskal M, et al: Aortobronchial fistula as a late complication of posttraumatic chronic aortic aneurysm. AJR 1995; 164: 1511-1513
  25. ↑ MacIntosh E, Parrott J, Unruh H: Fistulas between the aorta and tracheobronchial tree. Ann Thorac Surg 1991; 51:515-519
  26. ↑ Favre J, Gournier J, Adham M, et al: Aortobronchial fistula: report of three cases and review of the literature. Surgery 1994; 115:264-270
  27. ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763467/. Missing or empty |title= (help)
  28. ↑ http://www.revespcardiol.org/en/acute-clinical-presentation-of-pseudoaneurysm/articulo/90460465/. Missing or empty |title= (help)
  29. ↑ https://casereports.bmj.com/content/2014/bcr-2014-207374. Missing or empty |title= (help)
  30. ↑ https://www.jtcvs.org/article/S0022-5223(03)00128-4/fulltext. Missing or empty |title= (help)
  31. ↑ https://www.jtcvs.org/article/S0022-5223(03)00128-4/fulltext. Missing or empty |title= (help)
  32. ↑ http://www.bjcvs.org/article/1049/Aneurisma-do-arco-aortico-com-fIstula-aorto-pulmonar--tratamento-cirurgico-com-sucesso. Missing or empty |title= (help)
  33. ↑ Miyata T, Ohara N, Shigematsu H, et al: Endovascular stent graft repair of aortopulmonary fistula. J Vasc Surg 1999; 29:557-560
  34. ↑ Campagna A, Wehner J, Kirsch C, et al: Endovascular stenting of an aortopulmonary fistula presenting with hemoptysis. J Cardiovasc Surg 1996; 37:643-646
  35. ↑ Lawrence W, Kern J, Tribble C: Repair of aortobronchial fistula using extraanatomic grafts and hypothermic arrest. Ann Thorac Surg 1997; 63:1158-1160
  36. ↑ https://academic.oup.com/eurheartj/article/38/37/2853/2725556. Missing or empty |title= (help)
  37. ↑ https://www.ncbi.nlm.nih.gov/pubmed/29022410. Missing or empty |title= (help)
  38. ↑ https://www.ncbi.nlm.nih.gov/pubmed/29939255. Missing or empty |title= (help)
  39. ↑ https://onlinelibrary.wiley.com/doi/abs/10.1111/jocs.12212. Missing or empty |title= (help)
  40. ↑ https://www.ncbi.nlm.nih.gov/pubmed/27440801. Missing or empty |title= (help)
  41. ↑ https://www.ncbi.nlm.nih.gov/pubmed/27151885. Missing or empty |title= (help)
  42. ↑ https://www.ncbi.nlm.nih.gov/pubmed/27449901. Missing or empty |title= (help)

External Links

Goldminer: Aortopulmonary fistula


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