AORTIC DISSECTION AFTER AORTIC-VALVE REPLACEMENT - REPORT OF A CASE WITH AN AORTOCAMERAL FISTULA

A 58-year-old Japanese woman who had a history of aortic valve replace ment for congenital bicuspid valve, was admitted for investigation of facial edema and of pulselessness of the right leg. Physical examinati on disclosed the patient suffering from a superior vena cava syndrome. On auscultation, a continuous murmur was heard at the left lower ster nal border. Computed tomographic scans revealed aortic dissection exte nding from the ascending aorta to the bifurcation. Echocardiography sh owed an intimal nap in the dilated ascending aorta, but not abnormal b lood flow from the aorta to the right atrium was detected. Cardiac cat heterization and aortography, however, allowed a correct diagnosis of aortic dissection with fistula to the right atrium and with obstructio n of the right common iliac artery. The patient received emergency aor tic root replacement and reconstruction of the coronary arteries and t hen recovered uneventfully.