P333 A RARE CAUSE OF SHOCK: AORTO–PULMONARY FISTULA AS AORTIC ANEURYSM COMPLICATION

Abstract Clinical case A 69–year–old man with right shoulder discomfort, malaise for one hour and hemodynamic instability was admitted to our Emergency Department (ED). The patient had a history of arterial hypertension, diabetes, renal failure on peritoneal dialysis ischemic cardiomyopathy preserved ejection fraction treated by angioplasty stent implantation coronary. At first medical contact out hospital the appeared confused severe hypotension (BP 70/40 mmHg). ECG transmitted Cardiology Unit showed sinus tachycardia repolarization abnormalities consistent diffuse ischemia. centralized clinical suspicion acute coronary syndrome complicated cardiogenic shock. In ED, BP 65/35 mmHg. On physical examination extremities were cold mottled, crackles in lower lung zones turgid jugulars present. Pulses weak but repeated no evolutive signs detected. Echocardiography finding were: not dilated left ventricle global systolic function at limits, moderate aortic insufficiency, dimensions upper limits hypocontractile, tricuspid regurgitation, inferior vena cava inspiratory collapse. Aortic root non dilatated arch 55 mm images dissection flap. blood test lactates 4,2 metabolic acidosis, troponin just above limit, inflammation indices negative electrolytes range. Vasopressor support norepinephrine started. With high disease, CT angiography performed showing voluminous aneurysm 70x56 rupturing into pulmonary artery (Figure 1,2). Concomitant bilateral iliac Cardiac Vascular Surgeons promptly alerted plan tan emergent surgical intervention whose complexity increased difficult vascular cannulation dissection. However, patient‘s rapidly deteriorated requiring intubation and, after subsequent episodes cardiac arrest pulseless electrical activity (PEA), his death assessed.