Aortobronchopulmonary Fistula Caused by a Thoracic Aortic Aneurysm / 日本心臓血管外科学会雑誌

ABSTRACT

Aortobronchopulmonary fistula (ABPF) caused by thoracic aortic aneurysm is uniformly fatal if not treated surgically. Here we report 12 cases, and discuss the cause, surgical treatment, and results. Between 1993 and 1998, we encountered 12 cases of ABPF. ABPFs were complicated by (A) true aneurysms without infection (<i>n</i>=4), (B) aortic dissection (<i>n</i>=1), and (C) infective pseudoaneurysms occurring after thoracic aortic surgery (<i>n</i>=4). Three patients refused surgery. The ABPFs were located in the ascending aorta to the trachea (<i>n</i>=1), the distal arch to the upper lobe of the left lung (<i>n</i>=6), and the descending aorta to the lower lobe (<i>n</i>=5). They were repaired by graft replacement or patch closure. All four patients in group A have shown an uneventful course 10 patient-years after surgery. One patient in group B died of mediastinitis. The other three patients in group B were discharged from hospital, but died of sudden recurrent hemoptysis at their homes. A patient with aortic dissection underwent patch closure of an ABPF located at the distal arch, however he died of recurrent hemoptysis due to bleeding from another ABPF at the descending aorta. All of the three patients who refused surgery died of hemoptysis at various times after diagnosis. The surgical results in the non-infection group (A) were satisfactory. The group with infection (C) showed poor results after surgery and died due to recurrence of hemoptysis caused by new ABPFs arising from infected pseudoaneurysms. ABPF caused by aortic dissection (B) is difficult to repair because of severe adhesions to the lung and the unclear location of the fistula. ABPF infection is difficult to control after thoracic surgery and it is the reason for the fatal outcomes, due mainly to sudden hemoptysis. Early diagnosis and prompt surgical intervention are important for patients with ABPF.