An aortic-right ventricular fistula of more than eighteen months' duration: an approach to dynamics.

THE establishment of a fistulous tract between the aorta and the right ventricle poses critical problems in cardiopulmonary dynamics. The higher aortic pressure drives an excessive flow of blood into the right ventricle and overloads it. The increased pulmonary arterial pressure and blood flow lead to pulmonary edema and right heart failure, thereby precipitating a fulminating course and early death in most patients who develop such a fistula.1-3 We have observed a patient with such a fistula that had been present for at least 18 months. Anatomic findings in the heart suggest a possible mechanism for the prolonged survival.