Conservative management involving gut rest, antibiotics, and thoracic lavage successfully closed an iatrogenic esophageal-pleural fistula 52 days after TEE-guided left atrial appendage closure.
Case Report (n=1)
No
Highlights a rare but severe complication of TEE-guided LAAC (esophageal-pleural fistula) and demonstrates that conservative management can be a viable option in high-risk patients.
Periprocedural complications of left atrial appendage occlusion (LAAC) are varied and potentially life-threatening. We report a rare case of an iatrogenic esophageal-pleural fistula following a TEE-guided LAAC procedure. A 77-year-old woman with atrial fibrillation and a contraindication to long-term anticoagulation underwent successful LAAC. Her post-operative course was complicated by a pneumothorax and persistent pleural effusion. The diagnosis of an esophageal-pleural fistula was established after analysis of the chest tube drainage revealed food particles. Given her age and active infection, a non-surgical, conservative management strategy was adopted, involving complete gut rest, broad-spectrum antibiotics, thoracic lavage, and enteral nutrition support. The fistula closed after 52 days of conservative management, confirmed by follow-up imaging. This case underscores that while TEE-related esophageal injury is exceedingly rare, it must be considered in cases of persistent post-procedural pleural effusion. Furthermore, it demonstrates that in selected high-risk patients, a conservative approach can be a viable management option. The decision to perform a pre-procedural upper GI evaluation remains complex, given the very low incidence of this complication.
Qiu et al. (Wed,) conducted a case report in Atrial fibrillation and esophageal-pleural fistula (n=1). Conservative management (gut rest, antibiotics, thoracic lavage, enteral nutrition) was evaluated on Fistula closure. Conservative management involving gut rest, antibiotics, and thoracic lavage successfully closed an iatrogenic esophageal-pleural fistula 52 days after TEE-guided left atrial appendage closure.