Aortopulmonary fistula: Difference between revisions
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:*[[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 breakdown 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> | :*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> | :*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> | ||
Revision as of 01:02, 5 February 2019
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
- Complication of surgery or thoracic aortic graft [9]
- Indwelling chest tube, spinal fixation device, or foreign body
- Congenital [10]
- 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 [11]
- Infectious aortitis [12]
- Aortic dissection [13]
- Traumatic aortic tear [14]
- Aortic suture line breakdown Some other risk factors for aortopulmonary fistula are given below.
- Repair of coarctation of aorta[15]
- Use of Dacron draft for aortic repair surgery. Elective thoracic endovascular aortic repair is comparatively a safer option. [16]
- Bentall Operation [17]
- Marfan's Syndrome
- Atheroseclerotic inflammation
- Hypertension[18]
- Blunt chest trauma
- Transcatheter pulmonary valve placement
- Ross procedure [19]
- pulmonary angioplasty[20]
- Truncus arteriosus repair[21]
Diagnosis
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.[22] [23]. 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.[24] Sudden lipothymia and anemia can also indicate aortopulmonary fistula.[25] A person can have bounding pulse, prominent precordium, palpable thrill and murmur. There could be crackles and ronchi heard on auscultating lungs.
Chest x-ray
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.
- Endovascular stenting [26] [27]
- Surgery [28]
- percutaneous amplatzer septal occluder [29]
- Amplatzer occulder using antegrade venous approach might decrease the risk of subsequent cardiac surgery as well.[30]
- Conventional elephant trunk implantation[31]
- pericardial patc closure and tube graft[32]
Other options which are still under trial includes
- Amplatzer occlude via percutaneous catheterization[33]
- pulmonary artery catheterization with thoracotomy
References
- ↑ https://www.rightdiagnosis.com/medical/aortopulmonary_fistula.htm. Missing or empty
|title=(help) - ↑ https://www.medscape.com/viewarticle/410487. Missing or empty
|title=(help) - ↑ Killen D.A, Aortopulmonary Fistula, South Med J 93(2), 2000
- ↑ MacIntosh E, Parrott J, Unruh H: Fistulas between the aorta and tracheobronchial tree. Ann Thorac Surg 1991; 51:515-519
- ↑ 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
- ↑ DeProphetis N, Armitage H, Triboletti E: Rupture of tuberculous aortic aneurysm into lung. Ann Surg 1959; 150:1046-1051
- ↑ Favre J, Gournier J, Adham M, et al: Aortobronchial fistula: report of three cases and review of the literature. Surgery 1994; 115:264-270
- ↑ 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
- ↑ Jones J: Complications of the surgery of patent ductus arteriosus. J Thorac Surg 1947; 16:305-313
- ↑ https://www.internationaljournalofcardiology.com/article/S0167-5273(14)01251-0/fulltext. Missing or empty
|title=(help) - ↑ Coblentz C, Sallee D, Chiles C: Aortobronchopulmonary fistula complicating aortic aneurysm: diagnosis in four cases. AJR 1988; 150:535-538
- ↑ DeProphetis N, Armitage H, Triboletti E: Rupture of tuberculous aortic aneurysm into lung. Ann Surg 1959; 150:1046-1051
- ↑ 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
- ↑ Szolar D, Riepl T, Stiskal M, et al: Aortobronchial fistula as a late complication of posttraumatic chronic aortic aneurysm. AJR 1995; 164: 1511-1513
- ↑ https://www.scholars.northwestern.edu/en/publications/aortopulmonary-fistula-in-an-infected-dacron-graft-for-coarctatio. Missing or empty
|title=(help) - ↑ https://www.ncbi.nlm.nih.gov/pubmed/28795035. Missing or empty
|title=(help) - ↑ https://www.academia.edu/36458364/Acquired_aortopulmonary_fistula_in_pseudoaneurysm_of_the_aorta_six_years_after_a_bentall_operation. Missing or empty
|title=(help) - ↑ https://www.ncbi.nlm.nih.gov/pubmed/27527829. Missing or empty
|title=(help) - ↑ 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) - ↑ http://www.revespcardiol.org/en/percutaneous-closure-of-iatrogenic-aortopulmonary/articulo/90273733/. Missing or empty
|title=(help) - ↑ https://www.ncbi.nlm.nih.gov/pubmed/25193221. Missing or empty
|title=(help) - ↑ MacIntosh E, Parrott J, Unruh H: Fistulas between the aorta and tracheobronchial tree. Ann Thorac Surg 1991; 51:515-519
- ↑ Favre J, Gournier J, Adham M, et al: Aortobronchial fistula: report of three cases and review of the literature. Surgery 1994; 115:264-270
- ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763467/. Missing or empty
|title=(help) - ↑ http://www.revespcardiol.org/en/acute-clinical-presentation-of-pseudoaneurysm/articulo/90460465/. Missing or empty
|title=(help) - ↑ Miyata T, Ohara N, Shigematsu H, et al: Endovascular stent graft repair of aortopulmonary fistula. J Vasc Surg 1999; 29:557-560
- ↑ Campagna A, Wehner J, Kirsch C, et al: Endovascular stenting of an aortopulmonary fistula presenting with hemoptysis. J Cardiovasc Surg 1996; 37:643-646
- ↑ Lawrence W, Kern J, Tribble C: Repair of aortobronchial fistula using extraanatomic grafts and hypothermic arrest. Ann Thorac Surg 1997; 63:1158-1160
- ↑ https://academic.oup.com/eurheartj/article/38/37/2853/2725556. Missing or empty
|title=(help) - ↑ https://www.ncbi.nlm.nih.gov/pubmed/29022410. Missing or empty
|title=(help) - ↑ https://www.ncbi.nlm.nih.gov/pubmed/29939255. Missing or empty
|title=(help) - ↑ https://onlinelibrary.wiley.com/doi/abs/10.1111/jocs.12212. Missing or empty
|title=(help) - ↑ https://www.ncbi.nlm.nih.gov/pubmed/27449901. Missing or empty
|title=(help)