Acute right heart failure due to aortic aneurysm: 2 patients with an aortocaval shunt
Ansari Moein, C.M.; Bellens, L.; Pasteuning, W.H.; van Straten, A.H.M.; Roukema, J.A.
Nederlands Tijdschrift Voor Geneeskunde 146(35): 1653-1656
2002
ISSN/ISBN: 0028-2162 PMID: 12233163 Document Number: 541237
Two patients, a 72-year-old man and a 34-year-old woman, presented with severe pain in the lower back and abdomen, respectively, accompanied by acute dyspnoea. One patient presented additionally with a palpable pulsatile abdominal mass and a continuous harsh bruit. He subsequently developed massive haemoptysis and went into deep shock. The second patient presented with peripheral cyanosis and a loud systolic heart murmur. She developed increasing respiratory distress and was maximally supported in the intensive care unit. Further investigation revealed acute left-to-right shunting based on rupture of an aortic aneurysm into the venous system in both patients; in the first this was into the V. cava inferior and in the second this was into the right atrium. In both patients, high-output heart failure was present. Acute right heart failure due to a fistula between the aorta and the venous system is a life-threatening and rapidly worsening haemodynamic disturbance. The diagnosis is not difficult but the condition is rare. In some cases, the patient's survival can be achieved by prompt diagnosis followed by operative closure of the fistula.