Left Atrial to Esophageal Fistula: A Case Report and Literature Review
Left Atrial to Esophageal Fistula: A Case Report and Literature Review
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DOI：
10.12659/ajcr.899878
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发表时间：
2016-11-02
影响因子：
1.2
通讯作者：
Karabulut, Nigahus
中科院分区：
文献类型：
--
作者：
Khan, Muhammad Yasir;Siddiqui, Waqas Javed;Karabulut, Nigahus
目的：不寻常的临床病程背景：左心房至食道瘘（LAEF）是房颤射频消融（RFA）治疗的一种罕见致命并发症，与高死亡率相关。临床特征可以是非特异性的，包括发热，吞咽困难，上消化道（GI）出血，败血症，栓塞性中风后，最近的历史RFA的房颤。病例报告：一个57岁的白人男性被带到急诊室（艾德），因为他的家人改变了精神状态。三周前，他因阵发性房颤接受了射频消融术。在进入艾德几小时后，患者短暂性无反应，右侧偏瘫。脑部MRI显示多发性脑梗死。第二天，患者发生黑便，进行食管胃内窥镜检查（EGD），未发现任何出血源。当患者在重症监护室（ICU）接受监测时，他发生呕血并进入心脏骤停，他被成功复苏并转移到另一家机构。他有另一个EGD，发现一个皮瓣的粘膜覆盖下三分之一的食管和1厘米的瘘管开口被认为是新鲜血液渗出it.The病人有另一个心脏骤停在内窥镜检查和死亡，尽管所有measurements.Conclusions：我们提出这种情况下，强调LAEF的早期诊断的重要性。如果诊断延迟或漏诊，LAEF可能是致命的。早期手术干预可降低LAEF的发病率和死亡率。较新的诊断方式，如内窥镜超声（EUS）可以在常规成像不清楚的情况下有所帮助。
Objective: Unusual clinical courseBackground: Left atrial to esophageal fistula (LAEF) is a rare fatal complication of radiofrequency ablation (RFA) for atrial fibrillation and is associated with high mortality. Clinical features can be nonspecific and include fever, dysphagia, upper gastrointestinal (GI) bleeding, sepsis, and embolic stroke a after recent history of RFA for atrial fibrillation.Case Report: A 57-year-old Caucasian male was brought to the emergency department (ED) by his family because of an altered mental status. He had undergone a radiofrequency ablation for paroxysmal atrial fibrillation three weeks earlier. Several hours after admission to the ED, the patient transiently became unresponsive and had a right sided hemiplegia. A brain MRI revealed multiple cerebral infarcts. On the following day, the patient had an episode of melena, and an esophagogastroduodenoscopy (EGD) was performed which did not reveal any source of bleeding. While the patient was being monitored in the intensive care unit (ICU), he had an episode of hematemesis and went into cardiac arrest from which he was successfully resuscitated and transferred to another facility. He had another EGD, which uncovered a flap of mucosa covering the lower third of his esophagus and a 1 cm fistulous opening was seen with fresh blood oozing out of it. The patient had another cardiac arrest during the endoscopy and died despite all measures.Conclusions: We present this case to stress the importance of early diagnosis of LAEF. LAEF can be fatal if diagnosis is delayed or missed. Early surgical intervention can reduce LAEF morbidity and mortality. Newer diagnostic modalities such as endoscopic ultrasound (EUS) can be helpful in cases where conventional imaging is unclear.