Post Bentall procedure with perigraft leak and Cabrol fistula

Case contributed by Dr Vincent Tatco

Presentation

Post Bentall procedure with Cabrol fistula for Stanford A aortic dissection. Months after surgery, the patient presented with signs and symptoms of heart failure.

Patient Data

Age: 45
Gender: Male

A metallic valve prosthesis is seen at the region of the aortic valve.  The ascending aorta is replaced by a prosthetic graft with dense felt rings marking and reinforcing the sites of anastomosis.  These findings are consistent with changes after Bentall procedure.

There is accumulation of opacified blood in the perigraft space presumed from intractable leak at the region of the aortic root (perigraft leak).  The engorged perigraft space compresses the superior vena cava, main and right pulmonary arteries.

A patent Cabrol fistula is seen as a tubular communication between the perigraft space and the right atrium.

Intimal flap from prior dissection is evident in the arch and descending segment of the aorta.

There is cardiomegaly, reflux of contrast into the inferior vena cava and bilateral pleural effusion. 

Post-sternotomy changes are also noted. 

Case Discussion

This case shows a patient who underwent repair of the aortic root and ascending aorta for Stanford A aortic dissection (Bentall procedure).  Intractable bleeding at the region of the aortic root was encountered during surgery which resulted to hematoma formation in the perigraft space.  The surgeon decided to create the Cabrol fistula to decompress the perigraft space.  The created fistula was expected to spontaneously close after surgery when the bleeding stops.  However, the bleeding persisted resulting to continuous flow of blood from the aorta into the perigraft space and eventually into the right atrium through the patent Cabrol fistula.  This left-to-right shunting of blood resulted to high-output cardiac failure.   

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Case information

rID: 42640
Case created: 1st Feb 2016
Last edited: 17th Apr 2017
Inclusion in quiz mode: Included

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