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Wu QL, Wang Q, Guo GX, Li YG, Xing Y, Zhao MZ, Li H, Li JB. A case of a death caused by an atrial-oesophageal-thoracic fistula after radiofrequency ablation of atrial fibrillation. J Forensic Leg Med 2022; 90:102374. [PMID: 35667313 DOI: 10.1016/j.jflm.2022.102374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 10/18/2022]
Abstract
The report is about a 49-year-old man with rheumatic heart disease and atrial fibrillation. He underwent mitral valve replacement, tricuspid valvuloplasty, and atrial fibrillation radiofrequency ablation in the hospital. He vomited blood on the 2nd postoperative day, and the bleeding gradually worsened thereafter. He had to have repeated drainage of large amounts of blood from his right thoracic cavity and digestive tract. He died suddenly after undergoing an oesophageal endoscopy on the 24th postoperative day. The autopsy revealed an atrial-oesophageal-thoracic fistula. By excluding the possibility of the fistula being caused by complications from nasoenteric feeding, tracheal intubation, and a foreign body ingestion, we determined that the atrial-oesophageal-thoracic fistula was a complication after radiofrequency ablation according to the finding of coagulation necrosis of the myocardial cells at the left atrium fistula. In addition, we also performed an elemental analysis on the radiofrequency ablation area and other cardiac tissues by scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS) and found five metal elements, Cr, Cu, Zn, Mn, and Ti, which specifically existed in the radiofrequency ablation area. This finding has the potential to serve as new evidence for radiofrequency ablation and is a worthy direction of research.
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Affiliation(s)
- Qi-Long Wu
- Department of Forensic Medicine, Faculty of Basic Medical Sciences, Chongqing Medical University, Chongqing, 400016, PR China; Chongqing Engineering Research Center for Criminal Investigation Technology, Chongqing, 400016, PR China; Chongqing Key Laboratory of Forensic Medicine, Chongqing, 400016, PR China
| | - Qi Wang
- Department of Forensic Medicine, Faculty of Basic Medical Sciences, Chongqing Medical University, Chongqing, 400016, PR China; Chongqing Engineering Research Center for Criminal Investigation Technology, Chongqing, 400016, PR China; Chongqing Key Laboratory of Forensic Medicine, Chongqing, 400016, PR China
| | - Gao-Xian Guo
- Department of Forensic Medicine, Faculty of Basic Medical Sciences, Chongqing Medical University, Chongqing, 400016, PR China; Chongqing Engineering Research Center for Criminal Investigation Technology, Chongqing, 400016, PR China; Chongqing Key Laboratory of Forensic Medicine, Chongqing, 400016, PR China
| | - Yong-Guo Li
- Department of Forensic Medicine, Faculty of Basic Medical Sciences, Chongqing Medical University, Chongqing, 400016, PR China; Chongqing Engineering Research Center for Criminal Investigation Technology, Chongqing, 400016, PR China; Chongqing Key Laboratory of Forensic Medicine, Chongqing, 400016, PR China
| | - Yu Xing
- Department of Forensic Medicine, Faculty of Basic Medical Sciences, Chongqing Medical University, Chongqing, 400016, PR China; Chongqing Engineering Research Center for Criminal Investigation Technology, Chongqing, 400016, PR China; Chongqing Key Laboratory of Forensic Medicine, Chongqing, 400016, PR China
| | - Min-Zhu Zhao
- Department of Forensic Medicine, Faculty of Basic Medical Sciences, Chongqing Medical University, Chongqing, 400016, PR China; Chongqing Engineering Research Center for Criminal Investigation Technology, Chongqing, 400016, PR China; Chongqing Key Laboratory of Forensic Medicine, Chongqing, 400016, PR China.
| | - Hongwei Li
- Technical Department of Interpol Corps of the Chongqing Public Bureau, Chongqing, China
| | - Jian-Bo Li
- Department of Forensic Medicine, Faculty of Basic Medical Sciences, Chongqing Medical University, Chongqing, 400016, PR China; Chongqing Engineering Research Center for Criminal Investigation Technology, Chongqing, 400016, PR China; Chongqing Key Laboratory of Forensic Medicine, Chongqing, 400016, PR China.
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Rana ZA, Hosmane VR, Rana NR, Emery DL, Goldenberg EM, Gardner TJ. Gastro-right ventricular fistula: a deadly complication of a gastric pull-through. Ann Thorac Surg 2010; 90:297-9. [PMID: 20609805 DOI: 10.1016/j.athoracsur.2009.11.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 10/06/2009] [Accepted: 11/11/2009] [Indexed: 10/19/2022]
Abstract
A 70-year-old patient presented with melena, dyspnea, and generalized weakness. An endoscopy revealed a deep ulcer with a pulsatile clot in the intrathoracic gastric tube that had been previously constructed for esophageal replacement. Shortly thereafter, the patient died of exsanguination secondary to a fistula between the stomach and the right ventricle. This complication presents a unique but deadly cause of gastrointestinal bleeding that mandates swift diagnosis and immediate surgical correction.
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Affiliation(s)
- Zeshan A Rana
- Christiana Care Health System, Center for Heart and Vascular Health, Newark, Deleware 19718, USA.
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Molina-Navarro C, Hosking SW, Hayward SJ, Flowerdew AD. Gastroaortic fistula as an early complication of esophagectomy. Ann Thorac Surg 2001; 72:1783-8. [PMID: 11722100 DOI: 10.1016/s0003-4975(00)02569-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Gastroaortic fistula following esophagogastrectomy is an uncommon and invariably fatal complication without urgent surgical intervention. We report 1 such case and review the world literature identifying 22 previous cases. It characteristically presents 2 to 3 weeks after esophagogastrectomy with an initial herald bleed, followed by a latent period with a mean duration of 10 hours (range: 30 minutes to 3 days) and final exsanguination. Only 1 patient in this series survived. Awareness is necessary to allow prompt diagnosis and treatment of this almost invariably lethal but curable condition.
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Affiliation(s)
- C Molina-Navarro
- Department of General Surgery, Poole General Hospital, United Kingdom.
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