Atrioesophageal fistula post atrial fibrillation ablation managed with an esophageal stent followed by surgical repair

Figure 1. Chest computed tomography (CT) images. The first image represents the first CT scan 2 weeks post ablation and 3 weeks prior to patient’s presenting to the emergency department with fever and strokes. Second and third CT are 2 days apart at the time of the atrioesophageal fistula presentation. Fourth CT is post stent placement; fifth CT is after surgical repair and showing the latissimus dorsalis interposed between the atrium and the esophagus.

Figure 2. Brain magnetic resonance imaging at presentation showing the multiple cerebellar infarcts with hemorrhagic conversion at the time of presentation.

Figure 3. Surgical procedure. From left to right: harvesting of the latissimus dorsalis muscle; the atrioesophageal fistula after the inflamed atrial myocardium was debrided; the latissimus dorsalis placed between the esophagus and left atrium after the primary repair of both structures; right thoracotomy used for the surgical repair.