Bronchovenous fistula on cardiopulmonary bypass during an emergency open thoracic aneurysm repair—A case report

Abstract

Objective: We report a case of systemic arterial air embolism (SAAE), complicating the open repair of a ruptured descending thoracic aneurysm and aorto-bronchial fistula, while on cardiopulmonary bypass. Method: A 55-year-old patient was placed on beating heart cardiac bypass, for the open repair of a ruptured type C descending thoracic aneurysm, complicated by an aorto-bronchial fistula. After an uncomplicated graft replacement and primary repair of the bronchial fistula, weaning off bypass was complicated by a significant amount of air within the left heart, associated with ST elevations and poor cardiac ejection. Results: Despite multiple attempts at de-airing, positive pressure ventilation consistently resulted in re-accumulation of air within the cardiac chambers and its sequelae. The patient was unable to be weaned off cardiac bypass, and the consequence of SAAE worsened her condition and she subsequently expired. Conclusion: Broncho-venous fistula (BVF) is a rare complication that has occurred in patients following CPB, and usually presents as a significant, continuous flow of air into the left heart, related to positive pressure ventilation and refractory to usual de-airing techniques. We advise that these clinical criteria along with blood entering the endotracheal tube be used to promptly identify BVF, so that urgent, life-saving treatment can be initiated. To our knowledge this is the fourth such case reported in the literature.