1. YASMINE DE BRUYNE SYMPOSIUM 14/01/95 AN UNUSUAL USE OF A VASCULAR ALLOGRAFT IN THE REPAIR OF AN INFECTIOUS AORTO-PULMONARY FISTULA H.C. Jumet CLINICAL HISTORY OF THE PATIENT l 1988Start of hemodialysis l 1992Septic events – Recurrent staphylococcus aureus sepsis – Vancomycin and Rifampicine treatment interrupted because of side effects – Biologically persistant inflammatory status l 1993Cardiac symptoms – Dyspnea at effort – Edema of the lower limbs – Hepatomegaly – Systolic murmur at the aortic level

2. YASMINE DE BRUYNE SYMPOSIUM 14/01/95 AN UNUSUAL USE OF A VASCULAR ALLOGRAFT IN THE REPAIR OF AN INFECTIOUS AORTO-PULMONARY FISTULA H.C. Jumet DIAGNOSTIC DATA l Transthoracic Echocardiography – slight dilatation of the left ventricle – mild pulmonary hypertension – moderated stenosis of the aortic valve l Abdominal CT-scan – hepatomegaly – slight ascites l Follow-up TTE – right and left heart failure – shunt at the level of the main pulmonary artery l Transesophageal Echocardiography – confirmation of the shunt between ascending aorta and main pulmonary artery l Cardiac Catheterisation – pulmonary hypertension (51/26/33 mmHg) – pulmonary capillary wedge at 20 mmHg – cardiac output > 8,5 l/min – left-right shunt estimated at 2,7/1 l Angiography – shunt just above the coronary arteries – normal coronarography

3. YASMINE DE BRUYNE SYMPOSIUM 14/01/95 AN UNUSUAL USE OF A VASCULAR ALLOGRAFT IN THE REPAIR OF AN INFECTIOUS AORTO-PULMONARY FISTULA H.C. Jumet COMMENT l Etiology described in the literature – rupture of ascending aorta aneurysm – penetrating injury – aortoplasty for correction of ascending aorta aneurysm l Classification l Diagnostic criteria – Clinically » symptoms and signs of heart failure – ECG » combined or left ventricle hypertrophy – Chest Xray » cardiomegaly » augmented vascular markings – Specific study » transthoracic echocardiography » cardiac catheterisation » angiography » NMR

4. YASMINE DE BRUYNE SYMPOSIUM 14/01/95 AN UNUSUAL USE OF A VASCULAR ALLOGRAFT IN THE REPAIR OF AN INFECTIOUS AORTO-PULMONARY FISTULA H.C. Jumet SURGICAL REPAIR l Indication – without surgical correction the shunt leads inevitably to pulmonary hypertension and cardiac failure l General approach – cardio-pulmonary bypass – transaortic/transpulmonary/through the window – direct suture or patch l Technical particularities and advantages of the reported case – maximal excision of the fistula and its surrounding tissue – anatomical reconstruction of the aorta and the pulmonary artery – use of a vascular allograft

5. YASMINE DE BRUYNE SYMPOSIUM 14/01/95 AN UNUSUAL USE OF A VASCULAR ALLOGRAFT IN THE REPAIR OF AN INFECTIOUS AORTO-PULMONARY FISTULA H.C. Jumet

6. YASMINE DE BRUYNE SYMPOSIUM 14/01/95 AN UNUSUAL USE OF A VASCULAR ALLOGRAFT IN THE REPAIR OF AN INFECTIOUS AORTO-PULMONARY FISTULA H.C. Jumet