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Lung autotransplantation can be a surgical alternative to gain access to the posterior mediastinum and the thoracic portion of the descending aorta through a sternotomy. We present a case of hemoptysis and bronchial obstruction due to a presumed infected aortobronchial fistula, secondary to stent graft placement in a patient with multiple previous surgeries for aortic coarctation, treated with lung autotransplantation and an extra-anatomic bypass., (© 2021 Wiley Periodicals LLC.)

Aorto-cardiac fistula is a rare but potentially life-threatening condition. We herein report a rare case of chronic aorto-right ventricular fistula formation secondary to a stab penetrating injury to the heart and aorta occurred 15 years ago. The aorto-right ventricular fistula was not found until 15 years after the incident. The fistula had been repaired successfully to prevent further deterioration of cardiac function. Here, we report the clinical presentation, diagnosis and treatment strategies of the aorto-right ventricular fistula, and discuss the possible etiology of the development of the fistula after the penetrating injury., (© 2020 Wiley Periodicals LLC.)

Objective: Tracheo-innominate fistula (TIF) is a rare but fatal complication of tracheotomy. To date, there is a paucity of literature regarding pediatric TIFs. The objectives of this study were to conduct a systematic review of literature on pediatric TIF following tracheotomy and describe three demonstrative cases from our institutional experience., Methods: We conducted a systematic review using MEDLINE, Embase, Cochrane Database of Systematic Reviews, Web of Science, and CINAHL. All studies with pediatric patients (under 18 years of age) who developed TIF following tracheotomy were included., Results: Fifty-four publications met inclusion criteria, reporting on 77 cases. The most common indication for tracheotomy was prolonged intubation and the need for ventilatory support (38.6%), with neurological comorbidities being the most common indication (72.7%). The mean time to TIF was 395.7 days (95% confidence interval, 225.9-565.5). Fifty-four patients (70.1%) presented with massive hemorrhage, whereas 18 patients (23.3%) presented with a sentinel bleeding event. The most common diagnostic interventions were computed tomography scan with or without contrast and bronchoscopy (55.8%). A substantial number of patients did not have any investigations (41.6%). Surgical management occurred in 70.1% of patients. Mortality was 38.6% in reported cases with variable follow-up periods., Conclusion: TIF may occur in long-term tracheostomy-dependent children, contrary to the conventionally described 3-week postoperative period. The mortality may not be as high as previously reported with timely intervention. Our results are limited by inherent risks of bias. Further research including well-designed cohort studies are needed to guide an evidence-based approach to TIF., Level of Evidence: NA Laryngoscope, 130:217-224, 2020., (© 2019 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: Coronary artery fistula is a rare anomaly of the coronary arteries which results from an abnormal connection between a coronary artery with a cardiac chamber or vessel. Coronary steal phenomenon can lead to functional ischemia of the myocardium. The condition has been described extensively, however, the modalities for diagnosing this condition continue to advance., Methods: This review summarizes the approach to managing this uncommon condition., Results: We discuss the various surgical options, including the technique involved in treating specific types of fistulas., Conclusion: We also review minimally-invasive options and trans-catheter closure along with indications for use of the different modalities., (© 2019 Wiley Periodicals, Inc.)

Gerbode defect and sinus of Valsalva aneurysm fistula are congenital and acquired forms of intracardiac shunt. The increasing prevalence of invasive, recurrent cardiovascular procedures cause tissue damage and has led to more iatrogenic and acquired cases of predominantly congenital shunt over time. We report 2 cases of acquired intracardiac fistula precisely defined by Real time three-dimensional transesophageal echocardiography (3DTEE). The first case is a 70-year-old male with Gerbode defect after second aortic valve replacement surgery due to prosthetic valve endocarditis and the other case is a 41-year-old male with sinus of Valsalva aneurysm fistula between aorta and right atrium post subclinical infective endocarditis. Advanced cardiac imaging techniques such as cardiac computerized tomography, MRI and Real time three-dimensional (3D) echocardiography help to precisely detect intracardiac fistula and provide detailed anatomic and physiologic information. The relatively low cost, lack of radiation exposure, portability and guiding characteristic make real time 3DTEE an imaging technique with arguably the most advantages. Surgical repair is the usual treatment for intracardiac shunt, and percutaneous catheter-based closure is a less invasive alternative., (© 2014, Wiley Periodicals, Inc.)

Aortic root abscess is a relatively common complication of aortic valve endocarditis. However, aortic root abscess and formation of a fistula from the aortic root to the right ventricular outflow tract in the setting of a native bicuspid aortic valve (BAV) is a rare event. We present consecutive echocardiographic images of unruptured periaortic abscess and fistulization of it to the right ventricle in 24 hours, in a patient with BAV and fever of unexplained origin., (© 2011, Wiley Periodicals, Inc.)

Objectives/hypothesis: Aortoesophageal fistula is a rare but life-threatening complication of foreign body ingestion. In spite of several strategies for treatment, there is little consensus regarding the optimal management of the entity. In this article, we present our experience in the diagnosis and treatment of patients with aortoesophageal fistula., Study Design: Retrospective study., Methods: A total of 3,209 admissions due to esophageal foreign body impaction were recorded in Second Xiangya Hospital between 1963 and 2010. Of these, 32 cases were complicated with aortoesophageal fistula. In these 32 patients, 19 were treated by open surgery and 13 were managed with nonsurgical measures. We compared different treatments of the patients and their clinical outcomes., Results: Foreign body and aortoesophageal fistula were found in all of these 32 cases in imaging examination and/or surgery. Three patients were completely cured and 16 patients died of fatal hemorrhage from the group of patients with surgical management. All 13 nonsurgically treated cases died., Conclusions: Early diagnosis and an aggressive surgical treatment without delay is the only form of effective therapy for the condition of aortoesophageal fistula. Imaging examination is helpful in diagnosis. In particular, three-dimensional computerized tomography is a safe, simple, and noninvasive examination method that has high sensitivity and specificity for the early diagnosis of aortoesophageal fistula., (Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.)

Coronary cameral fistulas are unusual congenital or acquired anomalous communications between an epicardial coronary artery and a cardiac chamber. We present such an unusual entity here of a coronary cameral fistula between the left anterior descending artery and the left ventricle that was repaired surgically. Coronary cameral fistula is a rare but surgically curable congenital heart defect.

Aortoenteric fistula is a dramatic and rare complication, which may occur following abdominal aortic surgery. In this report, we present images of a 65-year-old patient who presented with acute peritonitis two months after aortobifemoral bypass grafting operation with a bifurcated dacron graft. Colonoscopy clearly showed the pathology leading to acute abdomen: Intestinal fistulization of the graft.

Background: Liver involvement in hereditary haemorrhagic telangiectasia is mainly characterized by vascular malformations, such as telangiectasies and arteriovenous shunts, which are found in up to 80% of patients., Aim: To analyse the current knowledge and controversies regarding the epidemiological, pathological, clinical, diagnostic and therapeutic aspects of liver involvement in hereditary haemorrhagic telangiectasia. Methods Systematic survey analysis of the indexed studies dealing with the above mentioned topics., Results: No more than 8% of patients with hepatic vascular abnormalities will have a symptomatic liver disease, mainly consisting in high-output heart failure, portal hypertension or biliary disease., Conclusions: Colour Doppler ultrasonography is a non-invasive, highly accurate and relatively low-cost procedure for the screening of liver involvement in patients with hereditary haemorrhagic telangiectasia; computed tomography, magnetic resonance imaging and angiography can be reserved for the characterization of focal lesions and the study of severely ill patients in whom invasive therapeutic procedures are advisable. Patients with asymptomatic liver involvement should not receive any treatment, while the therapeutic options for symptomatic patients include treatment of the specific complication, invasive procedures for shunt reduction and liver transplantation. The newly developed antiangiogenetic therapies appear to be very promising, but still require further evaluation in clinical trials.

Development of left ventricular to coronary sinus fistula is a rare complication of mitral valve surgery. Three of the seven previously reported cases occurred following multiple valve replacement surgeries, all of which were thought to be secondary to a complication of surgery and all were treated with surgical closure of the fistula. We report a case of left ventricular to coronary sinus fistula occurring after two mitral valve replacement surgeries that was treated medically with favorable long-term results.

Background: The foramen ovale remains patent in about 25% of the population. Paradoxical embolism through a patent foramen ovale (PFO) may produce ischemic events. The closure of a PFO may prevent recurrence of cerebrovascular events. Percutaneous closure of a PFO is now-a-days a standard procedure and it appears to carry a low rate of complications. A surgical approach, in some cases, may be needed., Methods: A patient underwent percutaneous closure of PFO. There was a residual shunt after the procedure and a fistula between the aortic root-to-right atrium was subsequently discovered. Surgery was carried out using a "Port-Access technique" through a right anterior minithoracotomy., Results: Postoperative course was uneventful. Complete obliteration of the fistula was achieved., Conclusion: Minimally invasive surgery may be effective to treat PFO or even complications after previous percutaneous attempts of closure. An aesthetically acceptable conclusion, especially in young female patients, and a very low rate of morbidity may be accomplished.

A 39-year-old man had attempted to commit suicide using a small knife to penetrate the anterior chest wall. An emergency operation was performed successfully to repair the penetrating cardiac injury of the right ventricular outflow tract without using cardiopulmonary bypass. Two years after the operation, he was complained of dyspnea and a continuous murmur was detected. Echocardiography and cardiac catheterization revealed aorto-right ventricular fistula in the sinus of valsalva with aortic regurgitation. In operation, the healed laceration of the right coronary cusp and the fistula between aorta and right ventricle were identified. The fistula was closed using a Dacron patch and the aortic valve was replaced with a mechanical valve. Long-term follow-up of penetrating thoracic injuries is important for detecting underlying intracardiac lesions.

Coronary fistulas are uncommon after heart transplantation. We report two cases of fistulas from an atrial branch of the circumflex coronary artery to the left atrium after heart transplantation. This has not been previously reported in the literature. They were detected with transesophageal echocardiography, and images are shown for the first time. Transesophageal echocardiography may be useful in the follow-up of heart transplant recipients.

Aortic dissection with rupture into the right atrium is an extremely rare and rapidly fatal condition that may occur after cardiac surgery. We report the case of a 59-year-old woman with a 6-year history of heart transplantation who presented with subacute illness characterized by chest pain and severe cardiac decompensation accompanied by a continuous murmur in the precordium. The diagnosis of aortic dissection complicated by right atrial fistula was made by the combination of transthoracic and transesophageal echocardiographic examination.