Aortoesophageal fistula.

With the advent of cardiovascular and bypass procedures, aortoesophageal fistula has progressed from the stage of a pathologic curiosity to a treatable lesion. Although the causes of aortoesophageal fistula are varied, a remarkably consistent clinical picture emerges from study of this condition. Chiari's triad of midthoracic pain, sentinel hemorrhage, and a symptom-free interval followed by fatal exsanguination remains the most important clinical finding today. Although contrast esophagography, esophagoscopy, and aortography are important diagnositc aids, immediate left thoracotomy may be the only means of making the diagnosis and saving the patient when hemorrhage is profuse. In most cases (80 per cent of the present series) there is a symptom-free period varying from hours to days from the original sentinel hemorrhage to the final exsanguination. This permits the informed surgeon trained in cardiovascular technics an opportunity to salvage some of these patients. The various methods of aortic and esophageal repair are discussed.