Lemola Kristina, Sneider Michael, Desjardins Benoit, Case Ian, Han Jihn, Good Eric, Tamirisa Kamala, Tsemo Ariane, Chugh Aman, Bogun Frank, Pelosi Frank, Kazerooni Ella, Morady Fred, Oral Hakan
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, USA.
Circulation. 2004 Dec 14;110(24):3655-60. doi: 10.1161/01.CIR.0000149714.31471.FD. Epub 2004 Nov 29.
During left atrial (LA) catheter ablation, an atrioesophageal fistula can develop as a result of thermal injury of the esophagus during ablation along the posterior LA. No in vivo studies have examined the relationship of the esophagus to the LA. The purpose of this study was to describe the topographic anatomy of the esophagus and the posterior LA by use of CT.
A helical CT scan of the chest with 3D reconstruction was performed in 50 patients (mean age, 54+/-11 years) with atrial fibrillation before an ablation procedure. Consecutive axial and sagittal sections of the CT scan were examined to determine the relationship, size, and thickness of the tissue layers between the LA and the esophagus. The mean length and width of the esophagus in contact with the posterior LA were 58+/-14 and 13+/-6 mm, respectively. The esophagus had a variable course along the posterior LA. The esophagus was close (10+/-6 mm from the ostia) and parallel to the left-sided pulmonary veins (PVs) in 56% of patients and had an oblique course from the left superior PV to the right inferior PV in 36% of patients. The mean thicknesses of the posterior LA and anterior esophageal walls were 2.2+/-0.9 and 3.6+/-1.7 mm, respectively. In 98% of patients, there was a fat layer between the esophagus and the posterior LA. However, this layer was often discontinuous.
The esophagus and posterior LA wall are in close contact over a large area that may often lie within the atrial fibrillation ablation zone, and there is marked variation in the anatomic relationship of the esophagus and the posterior LA. Both the esophageal and atrial walls are quite thin. However, a layer of adipose tissue may serve to insulate the esophagus from thermal injury, explaining why atrioesophageal fistulas are rare.
在左心房（LA）导管消融过程中，沿左房后壁消融时食管热损伤可导致房室食管瘘。尚无体内研究探讨食管与左房的关系。本研究旨在利用CT描述食管和左房后壁的局部解剖结构。
对50例（平均年龄54±11岁）房颤患者在消融术前进行胸部螺旋CT扫描并三维重建。检查CT扫描的连续轴位和矢状位切片，以确定左房与食管之间组织层的关系、大小和厚度。与左房后壁接触的食管平均长度和宽度分别为58±14 mm和13±6 mm。食管沿左房后壁走行多变。56%的患者食管靠近（距开口10±6 mm）并平行于左侧肺静脉（PVs），36%的患者食管从左上肺静脉向右下肺静脉走行呈斜行。左房后壁和食管前壁的平均厚度分别为2.2±0.9 mm和3.6±1.7 mm。98%的患者食管与左房后壁之间有一层脂肪组织。然而，这层脂肪组织常不连续。
食管与左房后壁在大面积区域紧密接触，该区域常位于房颤消融区内，食管与左房后壁的解剖关系存在显著变异。食管壁和心房壁都很薄。然而，一层脂肪组织可能起到使食管免受热损伤的作用，这解释了为什么房室食管瘘很少见。
