Successful Treatment of a Juvenile Coarctatio Aortae Combined with Recurrent Aorto-Bronchial Fistulas by Aortic Homograft, Stents & Coilings, by Atypical Segment Resections(An 18 Years Long Follow-Up as Case Report)

Background: Symptomatic recurrent congenital aorto-pulmonale fistula (/APF) is relatively uncommon but a life threatening disease and condition. It can be appear recurrent with unsuspected combination of other cardiovascular anomalies which can produce certain atypical features-symptoms making the clinical diagnosis & therapy difficult.Symptoms, Diagnostic & Therapy Solutions: The young female, age 14 (1998) was delivered at our emergency amb. with a severe hemoptysis after a rapid bronchopulmonal infection. After an angiography & A-CT scan a significant juvenile coarctatio aortae & a post-stenotic pseudoaneurysm at the proximal thoracic aorta region was diagnosed. Bronchoscopy showed a solid intrabronchial haemorrhage in the left lower lobe from the segment 6. As first surgical step: Replacement of the dilated thoracic aorta segment by an aortic homo-graft & all the APF-s were clipping. Atypical left partial lobectomy was performed on segment 6. As second Step, (2002): Two aortic stent-grafts were inserted above the homograft, in a ”Stent in Stent” position. By super-selective angiography was shown APF-s around the homograft & at the aortic arch region from the anterior brachioceph. branch to the left bronchial system. Both APF wessels region were successfully coiled (2005-07-12). Step III. Surgical(2013): Excision the vascular conglomerate around the homograft & the region was covered by an opened “Aortic Silver-Graft” flap, as patch, with a left segment 6. resection. Step IV.: Because of a stich insufficiency at the proximal part of the homograft suture line, a third (2015) and later a fourth (2016) Valiant Stent-Graft were inserted, and extended by a “Carotid-Cross Over” and a left “Carotid-Subclavian” by-pass as stroke prevention.Conclusion: New onset and remissions of AP fistulas are frequent. Aortic Stent-Graft repair and Coiling is our preferred primer treatment of ABF in this time, due to avoidance of aortic cross-clamping and extra-corporeal circulation and thoracotomy with hemo- dynamic & thoracic instability and with serious infection risk, which are inherent at an open repair.