CONGRESS ABSTRACT

Background . Aorto-pulmonary fistula (APF) is a rare but potentially life-threatening condition, most commonly occurring as a complication of aortic surgery or aortic dissection. This case report describes a non-iatrogenic APF caused by a chronic aortic arch aneurysm, an uncommon etiology that is scarcely reported in the literature. Case Summary . 68-year-old woman was admitted for severe right heart failure (RHF) secondary to pulmonary hypertension (PH), refractory to high-dose diuretic therapy. Three months earlier, a chronic aneurysm of the aortic arch had been documented, but the underlying cause of PH remained undetermined. Targeted transthoracic echocardiography (TTE), using off-axis views guided by a high index of clinical suspicion, revealed abnormal aorto-pulmonary flow, subsequently confirmed by dedicated CT angiography. The patient underwent staged open surgical repair, resulting in complete closure of the fistula and full hemodynamic recovery. Postoperative course was uneventful, with marked improvement in pulmonary pressure and in right ventricular function. Conclusion : Prompt diagnosis, guided by high clinical suspicion and targeted, multimodal imaging, is essential for identifying rare and potentially life-threatening causes of pulmonary hypertension. Early diagnosis facilitates timely intervention of potentially reversible causes of pulmonary hypertension, like aorto-pulmonary fistula, leading to substantial symptom relief and improving patient outcomes.