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Iatrogenic atrio-esophageal fistula following a video-assisted thoracoscopic maze procedure: Is esophageal instrumentation justified even when the diagnosis is equivocal?


Department of Anesthesiology and Perioperative Medicine, Augusta University, Augusta, GA, USA

Correspondence Address:
Shvetank Agarwal
Department of Anesthesiology and Perioperative Medicine, Augusta University, 1120 15th Street BIW-2144, Augusta, GA, 30912
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_133_17

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Year : 2018  |  Volume : 21  |  Issue : 2  |  Page : 208-211

 

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A 74-year-old female underwent an uneventful bilateral thoracoscopic maze procedure for persistent atrial fibrillation with continuous transesophageal echocardiographic (TEE) guidance. She presented six weeks later with persistent fever and focal neurological signs. Computed tomography of the thorax revealed air in the posterior LA, raising suspicion for an abscess versus an atrioesophageal fistula (AEF). Before undergoing an exploratory median sternotomy, an esophagogastroduodenoscopy (EGD) was performed by the surgeon to check for any esophageal pathology. This however, resulted in sudden hemodynamic compromise that required intensive treatment with vasopressors and inotropes. In this case-report, we review the various intraoperative risk factors associated with the development of AEF during cardiac ablation procedures as well as the potential hazards of esophageal instrumentation with TEE, naso- or oro- gastric devices, and/or an EGD when an AEF is suspected.






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Department of Anesthesiology and Perioperative Medicine, Augusta University, Augusta, GA, USA

Correspondence Address:
Shvetank Agarwal
Department of Anesthesiology and Perioperative Medicine, Augusta University, 1120 15th Street BIW-2144, Augusta, GA, 30912
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_133_17

Rights and Permissions

A 74-year-old female underwent an uneventful bilateral thoracoscopic maze procedure for persistent atrial fibrillation with continuous transesophageal echocardiographic (TEE) guidance. She presented six weeks later with persistent fever and focal neurological signs. Computed tomography of the thorax revealed air in the posterior LA, raising suspicion for an abscess versus an atrioesophageal fistula (AEF). Before undergoing an exploratory median sternotomy, an esophagogastroduodenoscopy (EGD) was performed by the surgeon to check for any esophageal pathology. This however, resulted in sudden hemodynamic compromise that required intensive treatment with vasopressors and inotropes. In this case-report, we review the various intraoperative risk factors associated with the development of AEF during cardiac ablation procedures as well as the potential hazards of esophageal instrumentation with TEE, naso- or oro- gastric devices, and/or an EGD when an AEF is suspected.






[FULL TEXT] [PDF]*


        
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