Iatrogenic atrio-esophageal fistula following a video-assisted thoracoscopic maze procedure

Is esophageal instrumentation justified even when the diagnosis is equivocal?

Shvetank Agarwal, Muhammad Salman Tahir Janjua, Paramvir Singh, Nadine Odo, Manuel R Castresana

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)208-211
Number of pages4
JournalAnnals of Cardiac Anaesthesia
Volume21
Issue number2
DOIs
StatePublished - Apr 1 2018

Fingerprint

Esophageal Fistula
Digestive System Endoscopy
Fistula
Sternotomy
Abscess
Atrial Fibrillation
Stomach
Fever
Thorax
Hemodynamics
Air
Tomography
Pathology
Equipment and Supplies
Therapeutics

Keywords

  • Atrial fibrillation ablation
  • esophagogastroduodenoscopy
  • iatrogenic trioesophageal fistula
  • transesophageal echocardiography
  • video-assisted thoracoscopic maze procedure complications

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

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