Successful non-operative management of left atrioesophageal fistula following catheter ablation.

Atrioesophageal fistula (AEF) is a potentially lethal complication of catheter radiofrequency ablation for atrial fibrillation. A 49-year-old man with paroxysmal atrial fibrillation who underwent catheter ablation around the pulmonary vein was admitted 31 days after the procedure, suffering seizures and fever. Magnetic resonance imaging of the brain showed ischemia and multiple lesions of acute infarction in the right occipital lobe of the cerebrum. Computed tomography (CT) of the chest showed a small accumulation of air between the posterior left atrium and the esophagus, suggesting an AEF. Endoscopic snaring of the esophageal mucosa, repeated a few times, supported by nil by mouth and antibiotic therapy, resulted in improvement of his condition with no recurrence of symptoms. Subsequent chest CT scans confirmed disappearance of the leaked air and the patient was discharged home 45 days after admission with no neurological compromise.

Double-patch and glue repair of a postinfarction left ventricular pseudoaneurysm.

An 85-year-old man with appetite loss, lightheadedness, and leg edema was referred to our institution. Computed tomography and transthoracic echocardiography revealed a left ventricular pseudoaneurysm with a maximal diameter of 80 mm and severe mitral regurgitation. Coronary angiography showed 90% stenosis and total occlusion of the left circumflex artery at segments 11 and 12, respectively. He was diagnosed with postinfarction left ventricular pseudoaneurysm and underwent patch repair using two bovine pericardium patches and biological glue, mitral valve replacement, and coronary artery bypass grafting. His postoperative course was uneventful.

Successful surgical repair of pulmonary artery aneurysm and regurgitation.

Pulmonary artery aneurysm (PAA) is generally a rare lesion, and there is no definitive approach for it. We report the case of a 45-year-old man who was admitted for the evaluation of dyspnea. In childhood, he had been diagnosed with PAA with congenital pulmonary valve stenosis and regurgitation, and he had a percutaneous transvenous pulmonary valve commissurotomy. Transthoracic echocardiogram showed dilatation of the right atrium and right ventricle, with right ventricular hypertrophy. There was severe pulmonary valve regurgitation, and the main pulmonary artery was dilated to 68 mm in diameter. From the surgical findings, the left leaflet of pulmonary valve was torn from commissure with failure to coapt with the other leaflet. After direct sutures of edges of the left leaflet, a nearly normal valvular competence was restored. The PAA was repaired with a Y-shaped 24 × 12 mm Dacron graft replacement. The postoperative course was uneventful, and the patient was discharged.

Postinfarction heart rupture of posterior wall repaired by covering patch.

A 46-year-old man underwent emergency surgery for heart rupture after acute infarction of the posterior wall. Echocardiography revealed limited myocardial thinning, so rather than sutureless repair, a covering patch was used in view of the risk of recurrent rupture. Postoperative echocardiography showed the myocardial thinning had progressed to a wide defect, and computed tomography demonstrated that the covering patch had prevented a repeat rupture.