RESUMO
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.
Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Fístula Esofágica/etiologia , Fístula Esofágica/terapia , Fístula/etiologia , Fístula/terapia , Cardiopatias/etiologia , Cardiopatias/terapia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Doença Aguda , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etiologia , Infarto Cerebral/diagnóstico , Infarto Cerebral/etiologia , Fístula Esofágica/diagnóstico por imagem , Esofagoscopia , Fístula/diagnóstico por imagem , Átrios do Coração , Cardiopatias/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Lobo Occipital , Complicações Pós-Operatórias/diagnóstico por imagem , Veias Pulmonares , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
An 82-year-old woman, who underwent axillo-bifemoral bypass for infrarenal aortic occlusion and peripheral arterial occlusive disease 9 years before, was admitted to our hospital for swelling in the left subclavicular region. Ultrasound examination revealed a leak in the wall of the bypass graft with the formation of a false aneurysm. No signs of infection, either locally or systemically, were observed. Resection of the aneurismal segment with interposition using a Dacron graft was performed. Macroscopic findings during surgery confirmed an intact anastomotic region of the left axillary artery and Dacron graft. Two possible mechanisms for the formation of this false aneurysm, either cumulative stress on the graft over the years or Dacron graft biodegradation, were hypothesized.