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Asian Cardiovasc Thorac Ann 2007;15:453-454
© 2007 Asia Publishing EXchange Ltd

IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY

A Right Ventricle to Aorta Fistula Caused by a Fractured Sternal Wire

Zohair Al Halees, MD, Fadi Abdoun, MD, Charles C Canver, MD, Suleiman Kharabsheh, MD

King Faisal Heart Institute, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

For reprint information contact: Zohair Al Halees, MD, Tel: 966 1 464 7272 ext: 32113, Fax: 966 1 442 7482, Email: alhalees{at}kfshrc.edu.sa, King Faisal Heart Institute (MBC-16), King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia.

A 67-year-old male patient known with coronary artery disease underwent coronary revascularization 10 years previously. He presented recently with heart failure. Evaluation revealed severely impaired left ventricular function (Ejection fration 25–30%), occluded coronary artery bypass grafts with very diffuse triple vessel coronary artery disease. Additionally, there was an aorta to right ventricle fistula with 2:1 left to right shunt and evidence of pulmonary hypertension. He was referred for redo coronary artery revascularization and closure of the aorta to RV fistula which was thought to be a ruptured sinus of Valsava aneurysm.

At surgery, a fractured stainless steel wire used for sternal closure at first surgery was found lodged in the right ventricular outflow tract causing the fistula. Probably the broken wire in the retrosternal space, with the heart beating eroded into the RV cavity and got stuck in the right ventricular outflow tract (Figure 1Go). Due to continuous irritation by one of the broken ends, it created a fistula into the right coronary sinus of the aorta just above the right coronary ostium (Figures 2Go & 3Go). Retrospectively, the broken wire could be seen in the lateral chest X-Ray behind the sternum (Figure 4Go).


Figure 1
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  		Figure 1. The sternal wire is seen lodged in right ventricular outflow tract.

 

Figure 2
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  		Figure 2. The wire is seen through the fistulous connection in right Coronary sinus.

 

Figure 3
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  		Figure 3. The removed wire.

 

Figure 4
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  		Figure 4. The lateral Chest X-Ray demonstrating the broken wire behind the sternum.

 





This Article
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Right arrow Author home page(s):
Fadi Abdoun
Charles C Canver
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Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Al Halees, Z.
Right arrow Articles by Kharabsheh, S.
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PubMed
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Right arrow Articles by Al Halees, Z.
Right arrow Articles by Kharabsheh, S.
Related Collections
Right arrow Mediastinum
Right arrow Cardiac - other

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