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Severe obstructive sleep apnoea, aortic dissection and aortopulmonary fistula in a 56-year-old patient with syncope
  1. Muzzamil Anwar Jelani1 and
  2. Shravan Nosib2
  1. 1Internal Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  2. 2Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  1. Correspondence to Dr Shravan Nosib; shravan.nosib{at}


We present a case of a 56-year-old patient with obstructive sleep apnoea (OSA) presenting with acute decompensated heart failure and signs of cardiogenic shock. Echocardiography and CT imaging led to the diagnosis of acute type A aortic dissection (AD) complicated by aortopulmonary fistula (APF). The patient underwent successful surgical repair with complicated postoperative course including pulseless electrical activity arrest. This case highlights the underappreciated role of untreated OSA as a risk factor for AD. Furthermore, it presents an opportunity to review APFs as a rare complication of AD. We discuss the available evidence linking OSA and AD, review currently reported cases of APF, briefly outline the haemodynamics of this acute left-to-right shunt and discuss management of this rare but deadly complication.

  • Cardiovascular medicine
  • Heart failure
  • Hypertension
  • Cardiovascular system

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  • Contributors MAJ has written the case report. SN has written the discussion and edited the case report as well as managed the patient.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.