[Aortic pseudoaneurysm and aorta-right atrium fistula: a case report].

The development of an aortic pseudoaneurysm of the ascending aorta is described as a potential complication after composite graft surgery for combined disorders that simultaneously affect the aortic valve and ascending aorta; in the literature it has been reported to range from 7 to 25%. The aorta-right atrial fistula is an infrequent complication of aortic dissection and it is rarely diagnosed in association with aortic pseudoaneurysm. The pathophysiological mechanism of the first seems to be related to dehiscence of the suture line at the anastomosis site; in the second to anatomic contiguity between the aorta and right atrium. Our report refers to a 72-year-old man with a 3-year history of a Bentall composite aortic root replacement (modified by Kouchoukos), who presented with epigastric and chest pain accompanied with severe dyspnea. The diagnosis of aortic pseudoaneurysm complicated by right atrial fistula was made by the combination of transthoracic and transesophageal echocardiographic examination.