Aortopulmonary Fistulous Communication Between Stentless Root Xenograft and Homograft.

Aortopulmonary fistulas are a rare complication of aortic root replacements associated with aortic aneurysms. We describe a patient with a sinus of Valsalva pseudoaneurysm associated with a Freestyle root replacement that fistulized to a distal pulmonary valve homograft after having 2 prior aortic and pulmonary valve surgeries. After a failed endovascular closure attempt, he underwent a third operation for repair.