PMC5532055_01
(
A
) Computed tomography (CT) angiography. (
B
) Transthoracic echocardiography: parasternal short axis. (
C
) Transthoracic color Doppler echocardiography: parasternal short axis. (
D
) Angiography. C, Colon; LV, left ventricle; red arrow, ventriculocolonic fistula.
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Computed tomography (CT) of the chest demonstrated extravasation of contrast from the left ventricle (LV) into the colonic interposition graft ( Fig. 1A ). Transthoracic echocardiography demonstrated a left ventricular pseudoaneurysm ( Fig. 1B ), normal left ventricular function, mild-to-moderate mitral regurgitation, and no evidence of endocarditis. Doppler echocardiography demonstrated flow within the pseudoaneurysm ( Fig. 1C ), and angiography confirmed a left ventricular pseudoaneurysm ( Fig. 1D ) without significant coronary artery disease. 
(
A
) Entering the ventriculocolonic fistula tract. (
B
) Clot in the pericardial defect. (
C
) Actively bleeding ventriculocolonic fistula. (
D
) Repair of ventriculocolonic fistula. (
E
) Pericardial defect penetrating into the colonic interposition graft. (
F
) Repair of left ventricle (black arrow) and the pericardial-colonic defect (blue arrow).
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The fistula was entered at the level of the pericardial reflection, and a significant amount of clot and fibrosis were encountered in the communicating pericardial-colonic graft defect ( Fig. 2A , B ). There was a 1.5-cm defect with active extravasation, which was bordered by dense fibrous tissue, on the LV ( Fig. 2C ). Fig. 2D ). Fibrin sealant was applied as an adjunct to hemostasis. The colonic wall and the pericardium were fused ( Fig. 2E ). Given the patient's tenuous hemodynamics and the extensive surgery required for definitive repair, the decision was made to exclude the pericardium using an autologous pericardial patch ( Fig. 2F ).