Right-to-left shunt due to iatrogenic atrial septal defect manifested by aorto-caval fistula: a case report.

IF 0.8 Q3 ANESTHESIOLOGY JA Clinical Reports Pub Date : 2024-08-15 DOI:10.1186/s40981-024-00735-y

Takuya Kimura, Takuya Okada, Norihiko Obata, Yasushi Motoyama, Masaharu Nagae

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Abstract

Background: An aorto-caval fistula is a rare but critical complication of abdominal aortic aneurysm (AAA) rupture, leading to high-output heart failure and increased venous pressure. The anesthetic management of such cases, particularly when complicated by an intraoperative right-to-left shunt, is seldom reported.

Case presentation: A 71-year-old man with a history of atrial fibrillation and catheter ablation presented with heart failure and abdominal pain, leading to cardiac arrest. Imaging revealed an AAA rupture into the inferior vena cava. During emergency surgery, severe venous bleeding was managed using intra-aortic balloon occlusion (IABO). Transesophageal echocardiography (TEE) identified a right-to-left shunt due to an iatrogenic atrial septal defect.

Conclusion: Early TEE recognition and timely IABO intervention were crucial in managing this complex case, underscoring the importance of these techniques in similar emergency scenarios.

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因先天性房间隔缺损导致的右向左分流，表现为主动脉腔瘘病例报告。

背景：主动脉腔瘘是腹主动脉瘤（AAA）破裂的一种罕见但严重的并发症，可导致高输出性心力衰竭和静脉压升高。关于此类病例的麻醉处理，尤其是术中并发右向左分流时的麻醉处理，鲜有报道：病例介绍：一名 71 岁的男性患者曾有心房颤动和导管消融病史，因心力衰竭和腹痛导致心跳骤停。影像学检查发现 AAA 破裂进入下腔静脉。在急诊手术中，使用主动脉内球囊闭塞术（IABO）处理了严重的静脉出血。经食管超声心动图（TEE）发现，由于先天性房间隔缺损，导致右向左分流：结论：早期的 TEE 识别和及时的 IABO 干预是处理这一复杂病例的关键，凸显了这些技术在类似急诊情况下的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JA Clinical Reports ANESTHESIOLOGY-

CiteScore

1.30

自引率

0.00%

发文量

审稿时长

9 weeks

期刊介绍： JA Clinical Reports is a companion journal to the Journal of Anesthesia (JA), the official journal of the Japanese Society of Anesthesiologists (JSA). This journal is an open access, peer-reviewed, online journal related to clinical anesthesia practices such as anesthesia management, pain management and intensive care. Case reports are very important articles from the viewpoint of education and the cultivation of scientific thinking in the field of anesthesia. However, submissions of anesthesia research and clinical reports from Japan are notably decreasing in major anesthesia journals. Therefore, the JSA has decided to launch a new journal, JA Clinical Reports, to encourage JSA members, particularly junior Japanese anesthesiologists, to publish papers in English language.