Surgical repair of huge ascending aortic and arch aneurysms with aortic dissection combined with pulmonary artery dissection and aortopulmonary artery fistula.

An aortopulmonary artery fistula combined with aortic and pulmonary artery dissection is extremely rare, and very few cases have been reported to date. Herein, we present a 38-year-old man with huge ascending aortic, arch and thoraco-abdominal aneurysms with chronic aortic dissection, pulmonary artery dissection and aortopulmonary fistula. Surgery was performed to replace the ascending aorta and the entire arch combined with a conventional elephant trunk implantation to correct the pulmonary artery dissection and repair the aortopulmonary fistula under selective cerebral perfusion with deep hypothermic circulatory arrest. The patient recovered uneventfully. A second-stage operation will be needed to replace the thoraco-abdominal aorta.