Hemorragia digestiva masiva por fístulas secundarias de grandes vasos al tracto digestivo / Massive digestive hemorrhage from secondary fistulas of great vessels to the digestive tract

RESUMEN La formación de una fístula entre arterias de gran calibre y el tubo digestivo es una complicación infrecuente de la cirugía reconstructiva de los grandes vasos sanguíneos secundario al uso de prótesis vasculares, los cuales se manifiestan con hemorragias masivas con elevada mortalidad. Presentamos dos casos de fístula aorto-entérico y de fístula carotideo-esofágico que comparten características comunes como la manifestación clínica de hemorragia digestiva masiva y mortal en pacientes con antecedentes de colocación de prótesis vasculares.

ABSTRACT The formation of a fistula between large caliber arteries and the digestive tract is an uncommon complication of reconstructive surgery of the large vessels secondary to the use of vascular prostheses, which manifest themselves with massive hemorrhages with high mortality. We report two cases of aorto-enteric fistula and carotid-esophageal fistula that share common characteristics such as the clinical manifestation of massive and fatal gastrointestinal bleeding in patients with a history of vascular prosthesis placement.

Fístula aorto-atrial direita: uma complicação pós-endocardite infecciosa. Relato de caso / Right aorto-atrial fistula: a post-infective endocarditis complication. A case report

A fístula aorto-atrial direita é uma comunicação anômala, que representa uma grave e infrequente complicação da endocardite infecciosa. Neste estudo, relata-se o caso de um paciente de 53 anos, do sexo masculino, com histórico evolutivo patológico de endocardite infecciosa e acometimento de valva aórtica. Sob imagem de ecocardiograma, demonstrou-se abscesso perivalvar aórtico, estendendo-se à parede atrial direita, com necessidade de abordagem cirúrgica. Foram realizados a anuloplastia valvar aórtica e implante de valva mecânica. Após 1 mês de evolução pós-cirúrgica, realizou-se novo ecocardiograma, que acusou shunt de débito da raiz da aorta para o átrio direito. A conduta diante do caso foi discutida entre equipe clínica e cirúrgica, visando a possíveis falhas na terapêutica inicial. (AU)

Right aorto-atrial fistula is an anomalous communication that represents a serious and infrequent complication of infective endocarditis. This study reports the case of a 53-year-old male patient, with a pathological evolutionary history of infective endocarditis and aortic valve involvement. The echocardiogram shows an aortic perivalvar abscess extending to the right atrial wall, requiring a surgical approach. Aortic valve annuloplasty and mechanical valve implantation were performed. After a month of post-surgical evolution, a new echocardiogram was performed, which showed aortic root to right atrium shunt. The behavior in this case was discussed between the clinical and surgical teams, aiming at possible failures in the initial therapy. (AU)

Tratamiento endovascular de fístula aorto esofágica secundaria a cáncer de esófago: Caso clínico / Endovascular treatment of aorto-esophageal fistula due to esophageal cancer: Report of one case

Background: Esophageal squamous cell carcinoma can spread locally to neighboring organs in the mediastinum. When it invades the aorta, the patient may develop an aorto esophageal fistula (AEF), complication that carries a high mortality rate. We report a 62-year-old male with stage IV esophageal carcinoma who, after chemo radiation treatment, developed an AEF. He was successfully treated with the use of an aortic endograft. The patient died 13 months later due to progression of his cancer, without evidence of sepsis or new bleeding episodes.

Aorto-cavitary fistula: a complication of infective endocarditis / La fístula aorto-cavitaria: una complicación de la endocarditis infecciosa

Aorto-cavitary fistulae are rare complications of infective endocarditis. The diagnosis, in the absence of concomitant aortic valve disease, replacement of aortic valve with homograft or prosthetic valve, periannular abscess and negative blood culture, requires a high index of suspicion and has important prognostic and management significance. The sensitivity of the Modified Duke Criteria is challenged in this case report with a documented right sinus of valsalva fistula to the right ventricle seen on transthoracic echocardiography.

Los fístulas aorto-cavitarias son complicaciones raras de la endocarditis infecciosa. El diagnóstico - en ausencia de la enfermedad concomitante de la válvula aórtica, el reemplazo de válvula aórtica con homoinjertos o válvulas protésicas, absceso perianular, y cultivo de sangre negativo - requiere un alto índice de sospecha, y reviste gran importancia para la prognosis y el tratamiento. En este reporte de caso, se cuestiona la sensibilidad de los Criterios de Duke Modificados, con la documentación de una fístula del seno de valsalva derecho hacia el ventrículo derecho, observada en una ecocardiografía transtorácica.

Cierre espontáneo de fístula residual post cierre quirúrgico de fístula aorto-ventricular derecha traumática: Caso clínico / Spontaneous closure of a residual fistula after surgical closure of a traumatic aorto-right ventricular fístula: Report of one case

We report a 16-year-old boy, who suffered a right vent ride penetrating injury caused by a sharp blade that evolved to cardiac tampon. He underwent surgery and was discharged four days later. Thirteen days later, a cardiac murmur was found. An echocardiography showed an aorta-right ventricular fistula. Surgical closure was performed through an aortotomy on cardiopulmonary by pass. The control echocardiography showed a small residual fistula, which closed spontaneously three months later.

Fístula aortobroncopulmonar em pós-operatório tardio de coarctação da aorta / Fístula aortobroncopulmonar en postoperatorio tardío de coartación de aorta / Aortobronchopulmonary fistula in the postoperative period of aortic coarctation

JUSTIFICATIVA E OBJETIVOS: Em pacientes com hemoptise e história de cirurgia aórtica, a possibilidade de fístula aortobroncopulmonar deve sempre ser considerada. O objetivo deste estudo foi relatar um caso raro de hemoptise por fístula aortobroncopulmonar em pós-operatório tardio de cirurgia aórtica. RELATO DE CASO: Mulher, 34 anos, correção cirúrgica de coarctação de aorta na infância, apresentando hemoptise maciça. Ecocardiograma evidenciou pseudoaneurisma. Foi realizada a cirurgia e implantado tubo de dacron no segmento aórtico envolvido com sucesso. CONCLUSÕES: Fístula aortobroncopulmonar deve ser lembrada em pacientes com cirurgia aórtica prévia, principalmente pela elevada morbimortalidade se não diagnosticada e tratada precocemente.

BACKGROUND AND OBJECTIVES: In patients with hemoptysis and a history of aortic surgery, the possibility of aortobronchopulmonary fistula must always be considered. The objective of this study was to report a rare case of hemoptysis due to aortobronchopulmonary fistula in the late postoperative period of aortic surgery. CASE REPORT: Female patient, 34 years, surgical correction of aortic coarctation, presenting massive hemoptysis. The echocardiogram disclosed a pseudoaneurysm. The surgical correction was performed and a Dacron tube graft was implanted in the affected aortic segment successfully. CONCLUSIONS: Aortobronchopulmonary fistulas must be considered in patients with previous aortic surgery, due to the elevated morbimortality if they are not promptly diagnosed and treated.

JUSTIFICATIVA: En pacientes con hemoptisis e historia de cirugía aórtica, la posibilidad de fístula aortobroncopulmonar siempre debe tenerse en cuenta. OBJETIVOS: Relatar un caso raro de hemoptisis por fístula aortobroncopulmonar en postoperatorio tardío de cirugía aórtica. INFORME DE CASO: Mujer, 34 años, corrección quirúrgica de coartación de la aorta en la infancia, presentando hemoptisis masiva. Ecocardiograma mostró evidencias de seudoaneurisma. Se realizó la cirugía, implantándose con éxito un tubo de dacron en el segmento aórtico involucrado. CONCLUSIONES: La fístula aortobroncopulmonar debe ser considerada en pacientes con cirugía aórtica previa, principalmente por la elevada morbimortalidad cuando no es diagnosticada y tratada precozmente.

Aneurisma de aorta com ruptura para esôfago / Aortic aneurysm rupture into the esophagus

Apresentamos o caso de uma paciente portadora de aneurisma de aorta descendente com ruptura para o esôfago que, após aortoplastia com interposição de tubo de dacron e rafia da laceração esofágica, evoluiu com fístula esôfago pleural no terceiro dia pós-operatório. A paciente necessitou de reintervenção e cuidados intensivos, reabilitando-se adequadamente. A propósito deste caso incomum e do aprendizado adquirido no seu manejo, revisamos a literatura a fim de discutir a melhor alternativa de correção desta rara e, freqüentemente, fatal forma de apresentação das doenças da aorta.

We present the case of a patient with a descending aorta aneurysm rupture into the esophagus, which, after aortoplasty with Dacron tube interposition and suture of esophageal laceration, developed a pleural-esophagus fistula on the 3rd postoperative day. She needed re-intervention and intensive care, followed by adequate recovery. Considering this unusual case and the knowledge acquired through its management, we reviewed the literature in order to discuss the best alternative for the correction of this rare and often fatal form of presentation of aortic diseases.

[Spontaneous intrahepatic porto-cava shunt associated with chronic pericarditis. A case report]

Introduction: Spontaneous intrahepatic portosystemic shunts are rare vascular anomalies that consist of a communiation between the portal system and the systemic venous circulation. We report a case of a porto-caval shunt associated with chronic pericarditis

Case report: A 47-year-old patient with post pericarditis cirrhosis and without encephalopathy and hypoglycaemia. The shunt was tubular in its initial segment and aneurismal just before joining the vena cava

Discussion: Spontaneous intrahepatic portosystemic shunt is a rare anomaly. Diagnosis can ve made by Doppler ultrasound and helical CT

Aortic dissection with aortopulmonary artery fistula.

Rupture and dissection are the most dreaded complications of thoracic aortic aneurysm. Aortic dissection causing aortopulmonary artery fistulae is extremely rare. Here we report a case of chronic (type B) aortic dissection with fistulous communication between true lumen and main pulmonary artery.