Aorto-right atrial fistula caused by type A aortic dissection.

We present a rare surgical case of aorto-right atrial fistula caused by type A aortic dissection in an 85-year-old man. Complaints included progressive general fatigue and anorexia caused by right side heart failure. However, there were no symptoms attributable to onset of the aortic dissection. A diagnosis of aorto-right atrial fistula was made from intraoperative transesophageal echocardiography. Total aortic arch replacement concomitant with direct closure of the fistula was performed successfully.