Aortopulmonary artery fistula in atherosclerotic pseudoaneurysm presenting with congestive heart failure after aortic valve replacement.

An exceptional case of a giant pseudoaneurysm of the atherosclerotic ascending aorta complicated by aortopulmonary fistulization twelve years after aortic valve replacement is presented. The patient underwent successful surgical repair. In patients with a marked atherosclerotic thoracic aorta presenting with congestive heart failure and an acquired continuous systolo-diastolic murmur, aortopulmonary fistula should be considered and differentiated from ruptured sinus of valsalva aneurysm. Multi-slice computed tomography was the most useful diagnostic tool in planning surgical strategy and approach. Surgery is the treatment of choice for this serious albeit rare entity.