Case Report Successful Surgical Repair of an Infectious Thoracic Aortic Pseudoaneurysm Accompanied by Aortobronchopulmonary Fistula and Advanced Hepatic Dysfunction without Assisted Circulation Hiroshi Masuhara, MD,1 Yoshinori Watanabe, MD,1 Takeshiro Fujii, MD,1 Noritsugu Shiono, MD,1 Satoshi Hamada, MD,1 Masanori Hara, MD,1 Chikao Teramoto, MD,1 Katsunori Yoshihara, MD,2 and Nobuya Koyama, MD1 The patient was a 59-year-old female. Because of massive hemoptysis, she was brought to our emergency center by ambulance. Thoracic computed tomography led to a diagnosis of an infectious thoracic aortic pseudoaneurysm accompanied by an aortobronchopulmonary fistula. Emergency surgery followed. Also noted was an advanced hepatic dysfunction, assessed as Child-Pugh score B, caused by an alcoholic liver disease. A localized affected area made it possible for us to perform an aneurysmectomy using a temporary bypass rather than assisted circulation. A patch plasty using expanded polytetrafluoroethylene completed the procedure. Streptococcus agalactiae (GBS) was detected in a sample obtained during the surgery from an abscess located in the aneurysm. The patient made satisfactory postoperative progress and left the hospital walking unaided on the 36th postoperative day. (Ann Thorac Cardiovasc Surg 2010; 16: 35-39) Key words: advanced hepatic dysfunction, aortobronchopulmonary fistula, infectious thoracic aortic pseudoaneurysm, temporary bypass 1Division of Cardiovascular Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Toho University; and 2Division of Critical Care and Emergency Center, Toho University Omori Medical Center, Tokyo, Japan Received October 21, 2008; accepted for publication February 10, 2009. Address reprint requests to Hiroshi Masuhara, MD: Division of Cardiovascular Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Toho University, 6–11–1 Omorinishi, Ota-ku, Tokyo 143–8541, Japan.

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