Ruptured pseudoaneurysm of aortic root graft into the pulmonary artery as a cause of severe heart failure

A 52-year-old man presented with heart failure of 1 month duration. He had undergone aortic valve and root replacement 30 months before admission. A continuous murmur was heard in the second intercostal space at the parasternal border. Aortography showed a pseudoaneurysm surrounding the aorta, whereas color Doppler study revealed flow from the central aorta to the pseudoaneurysm and flow from the pseudoaneurysm to the pulmonary artery trunk through a fistulous communication between them. Thus, fistulous communication with pulmonary artery causing heart failure is a complication of pseudoaneurysm after aortic and root replacement, which can be diagnosed clinically and echocardiographically.