Type A aortic dissection complicated with fistulization into the right atrium and right-to-left shunt

Fistulization between the aorta and the right atrium is a rare complication of ascending aortic dissection. Because of the typical haemodynamic unstability, the diagnosis is often made by bedside or intraoperative transoesophageal echocardiography. The treatment is surgical, but with very high mortality. We describe a case of type A aortic dissection complicated with shock and fistulization into the right atrium with the right-to-left shunt through a patent foramen ovale. Surgical repair was successful.