Aortopulmonary Fistula Due to Perforation of the Aortic Wall of a Freestyle Stentless Valve

Aortopulmonary fistula occurring as a result of a rupture of the aortic wall of a stentless valve has not been previously reported. A 71-year-old woman suffered aortopulmonary fistula 15 months after replacement of the aortic root with a Freestyle stentless valve (Medtronic, Inc, Minneapolis, MN) and Dacron graft extension to replace the aortic valve and the ascending aorta to the aortic arch. We describe the successful repair of the fistula and simultaneous mitral valve replacement. The cause of deterioration of the aortic wall of the stentless valve, which gradually developed and ruptured, may have been primarily structural injury at the previous operation, with additional insult from the surgical adhesive used.