Pericardiocutaneous fistula: presentation with acute hemorrhage 8 years following aortic valve replacement.

Pericardiocutaneous fistula is a rare complication of cardiac surgery. A 35-year-old female presented with acute severe hemorrhage from a pericardiocutaneous fistula eight years following aortic valve replacement. Computed tomography showed a large, pericardial collection causing tamponade, connected to a smaller subcutaneous cavity, with a tract leading to the skin. The patient underwent emergency surgical exploration with removal of hematoma, hemostasis, and partial pericardectomy. One year following the operation, the patient remains stable. Factors in the development of pericardiocutaneous fistula were valve replacement, infection, and warfarin anticoagulation.