We report the case of a 72-year-old woman who developed new onset right ventricular failure after redo aortic valve replacement. The diagnosis of left to right shunt was initially made using two-dimensional transthoracic echocardiography (2DTTE) and 2D transesophageal echo with color Doppler (TEE). Definite diagnosis of aorto-right atrial and aorto-right ventricular fistula was made using three-dimensional transthoracic echocardiography (3DTTE) with color flow Doppler imaging. Early recognition and diagnosis of this rare surgical complication is imperative for prompt surgical repair of this lethal defect. 3DTTE should be utilized in cases of new onset heart failure with unclear etiology to diagnose unusual causes of this potentially fatal condition.

A 36-year-old white man presented with hemoptysis and hematemesis. The medical history was significant for a bipolar disorder and schizophrenia. He had swallowed 3 fishhooks and aspirated 1 into his lungs. A chest x-ray showed the fishhook in the right main stem bronchus. He underwent a flexible bronchoscopy for removal of the foreign object. The technique of the removal of the fishhook is described. Foreign object aspiration usually occurs in the pediatric or the geriatric population. Aspiration of foreign objects in adults is commonly associated with psychiatric illnesses in patients. After appropriate imaging, bronchoscopy or even cardiothoracic surgery is usually required for removal of the foreign object. Fishhooks may be more difficult to remove.