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A 36 year old man was admitted to a district general hospital, following a stab wound to his chest, in a state of circulatory collapse. He was resuscitated during emergency surgery with control of profuse bleeding from the front of his pulmonary artery.
He was transferred to the regional cardiothoracic unit for postoperative care. The following day a continuous murmur was heard at the second left intercostal space. Transoesophageal echocardiography (left) demonstrated a traumatic aortopulmonary fistula (APF) just above the aortic valve close to the left main coronary artery (LMS). Colour Doppler (right) showed flow across the fistula (AO, aorta; RVOT, right ventricular outflow tract). He developed fulminant pulmonary oedema and underwent urgent reoperation 48 hours after the first operation. During cardiopulmonary bypass, the fistula was closed by simple suture to lacerations of the aorta and posterior main pulmonary artery. Injury to the pulmonary valve leaflets was not repaired but the entry wound in the pulmonary valve sinus was resutured. He made a good postoperative recovery and was discharged home one week later.
Dr Vincent Moohan is acknowledged for providing the transoesophageal echocardiogram.