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Ann Thorac Surg 1977;23:378-388
© 1977 The Society of Thoracic Surgeons

Articles

Congenital Left Aortic Sinus-Left Ventricle Fistula and Review of Aortocardiac Fistulas

Edward R. Nowicki, M.D.*, Eoin Aberdeen, F.R.C.S., Sidney Friedman, M.D., William J. Rashkind, M.D.

Department of Surgery, Hospital of the University of Pennsylvania, the Department of Pediatrics, University of Pennsylvania School of Medicine, the Division of Cardiology, The Children's Hospital, Philadelphia, PA, and the Division of Cardiothoracic Surgery, Mt Sinai Medical Center, New York, NY.

* Address reprint requests to Dr. Nowicki, 7 Bramhall St, Portland, ME 04102.

A fistula from the left aortic sinus to the left ventricle is reported that was successfully repaired using cardiopulmonary bypass. In addition, 175 cases of fistula to the heart from the aortic sinuses published in the English literature from 1839 through 1972 were studied, with particular emphasis on the 126 patients who underwent operative repair.

The major cause of the fistulas (76%) was found to be rupture of a congenital aortic sinus aneurysm, usually during the third or fourth decade of life. The remainder of these fistulas to the heart consisted of simply a tract in an otherwise normal sinus. Ventricular septa1 defect was the most common associated defect and, when present, was nearly always related to a fistula arising from the right aortic sinus. Repair was successful in 86% of the 126 operated patients. The principles of operative treatment of these fistulas are reviewed.




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