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Aortopulmonary fistula after a modified Bentall procedure.

A 68-year-old man presented with aortic pseudoaneurysm and aortopulmonary fistula, due to dehiscence of the left coronary button anastomosis, at three months after surgery for acute aortic dissection using a composite conduit. At reoperation, the pulmonary trunk was repaired by direct suture and the coronary ostial anastomosis with single sutures, reinforced with pericardial pledgets from inside the aortic graft. Aortopulmonary fistula due to pseudoaneurysm formation is an extremely rare complication of operations on the proximal aorta. Furthermore, pseudoaneurysm caused by dehiscence of a coronary anastomosis complicated by an aortopulmonary fistula, as in the present case, has been previously reported only twice. Patients with acute aortic dissection, due to tissue fragility, appear particularly prone to develop such complications, which can occur even in the early postoperative period. Therefore, after the repair of acute aortic dissection, particularly when the insertion of a composite conduit is required, continuous follow up is mandatory for the early detection of this rare, but potentially lethal, complication.