Suzuki Satomi, Omori Keiko, Kimura Yuriko, Furuya Atsushi, Tamaki Fumimasa, Nonaka Akihiko
Department of Anesthesia, Yamanashi Prefectural Central Hospital, Kofu 400-8506.
Masui. 2012 Jan;61(1):93-5.
We describe a case of an esophageal injury caused by insertion of a transesophageal cardiac echo probe in a 66-year-old man with an aberrant right subclavian artery, who was scheduled for Bentall surgery for aortic regurgitation and annuloaortic ectasia. Preoperative CT scan showed an aberrant right subclavian artery compressed from the back of the esophagus. General anesthesia was induced with midazolam and fentanyl, and maintained with midazolam, remifentanil and fentanyl. After induction of anesthesia, a transesophageal cardiac echo probe was inserted without abnormal resistance. The operation was performed uneventfully. On the second day after surgery, gastrointestinal bleeding was suspected and the upper gastrointestinal endoscopy (GIF) was performed. GIF revealed ulceration at the mid-esophagus and gastroesophageal junction, and a large amount of fresh blood in the stomach. The location of the ulcer at mid-esophagus was likely to be over the aberrant right subclavian artery. Ulcers were treated conservatively. GIF on the postoperative day 16 revealed that ulcers had healed. Transesophageal echo probe insertion is potentially hazardous in a patient with an aberrant right subclavian artery. Although aberrant right subclavian artery is rare, transesophageal echocardiography should be performed with extreme caution.
我们描述了一例在一名66岁患有迷走右锁骨下动脉的男性患者中，因插入经食管心脏超声探头而导致食管损伤的病例，该患者计划接受Bentall手术治疗主动脉瓣反流和主动脉根部扩张。术前CT扫描显示迷走右锁骨下动脉从食管后方受压。使用咪达唑仑和芬太尼诱导全身麻醉，并使用咪达唑仑、瑞芬太尼和芬太尼维持麻醉。麻醉诱导后，经食管心脏超声探头插入时未遇到异常阻力。手术顺利进行。术后第二天，怀疑有胃肠道出血，遂进行了上消化道内镜检查（GIF）。GIF显示食管中段和胃食管交界处有溃疡，胃内有大量新鲜血液。食管中段溃疡的位置可能在迷走右锁骨下动脉上方。溃疡采用保守治疗。术后第16天的GIF显示溃疡已愈合。在患有迷走右锁骨下动脉的患者中插入经食管超声探头有潜在危险。尽管迷走右锁骨下动脉很少见，但进行经食管超声心动图检查时应极其谨慎。
