Acquired aortopulmonary fistula in pseudoaneurysm of the aorta six years after a bentall operation

Abstract

chest-tube bottle. A small hole (5 to 7 mm in diameter) was made in the body of the cylinder. This hole served as the only outlet for air leakage, and it closed with every mechanical inspiration. This caused the balloon to inflate (Fig. 1). The system was changed daily. A fresh, aseptic system was manually prepared near the patient. This required 5 minutes of hand work. Results. The result was immediate. Expired volume rose from 7.5 L/rain to 13 L/min. Ventilation was maintained on synchronized intermittent mandatory ventilation. Transcutaneous oxygen saturation rose from 93% to 96%. Blood pressure and heart rate remained unchanged. One day later, the patient was on spontaneous ventilation with inspiratory assistance of 25 cm H20. To verify the efficacy of our system, the balloon valve was removed for 15 minutes (Fig. 2). The system proved efficacious with whatever mode of mechanical ventilation was used. Daily radiographs showed no residual pneumothorax. Respiratory function continued to ameliorate and the BPF sealed completely on the twenty-first day of application of the system, so the pleural tube was removed. Definitive weaning from mechanical support was never possible. The patient's condition deteriorated progressively, and he died on the 159th day of intensive care (88 days after the sealing of his BPF) of multiple organ failure. Discussion. In a case of an inoperable BPF, all techniques of ventilation should be tried, l 'z as should a pleural drainage system. 35 The technique described here seemed efficacious, but further trials are necessary for evaluation. The risk of tension pneumothorax is relatively low with the technique because any high pleural pressure is transmitted to the valve and opposes inflation of its balloon.