Aortocameral fistula: a rare complication of aortic dissection.

The false channel of an aortic dissection only rarely ruptures into a cardiac chamber producing an aorto-cameral fistula. Reports of 20 cases have been published, and two distinct clinical patterns have emerged. In nine patients, severe cardiac decompensation associated with chest pain developed abruptly months to years after coronary bypass graft surgery or aortic valve replacement. Continuous murmurs were observed infrequently. In 11 patients, progressive chronic or subacute congestive heart failure developed in patients with aortic dissection known or suspected to have occurred months to years previously. A continuous murmur was almost always present. The frequency with which aortocameral fistula occurred in patients who had undergone cardiac surgery suggests a pathogenetic mechanism. It seems probable that postoperative adhesions favor fistula over free rupture.