医源性房间隔缺损导致主动脉-腔静脉瘘引起的右向左分流：一例报告
Right-to-left shunt due to iatrogenic atrial septal defect manifested by aorto-caval fistula: a case report.
作者信息
Kimura Takuya, Okada Takuya, Obata Norihiko, Motoyama Yasushi, Nagae Masaharu
机构信息
Department of Anesthesiology and Pain Clinic, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264 Kamiya-Cho, Himeji, Hyogo, 670-8560, Japan.
Division of Anesthesiology, Department of Surgery Related, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan.
出版信息
JA Clin Rep. 2024 Aug 15;10(1):50. doi: 10.1186/s40981-024-00735-y.
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.
背景
主动脉-腔静脉瘘是腹主动脉瘤（AAA）破裂的一种罕见但严重的并发症，可导致高输出量心力衰竭和静脉压升高。此类病例的麻醉管理，尤其是合并术中右向左分流时，鲜有报道。
病例介绍
一名71岁有房颤和导管消融病史的男性患者，因心力衰竭和腹痛就诊，随后发生心脏骤停。影像学检查显示腹主动脉瘤破裂至下腔静脉。在急诊手术期间，采用主动脉内球囊阻塞（IABO）处理严重的静脉出血。经食管超声心动图（TEE）发现因医源性房间隔缺损导致右向左分流。
结论
早期TEE识别和及时的IABO干预对处理这一复杂病例至关重要，凸显了这些技术在类似急诊情况下的重要性。
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