左房食管瘘的识别与处理

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1、左房食管瘘的识别与处理李毅刚上海交通大学新华医院SegmentalPVIsolationCircumferentialAblationCircumferentialIsolationCafes房颤介入治疗方法LUPVLLPVRUPVRLPVSCVICVIRAAFSCVICVRUPVRLPVLUPVLLPVPappone环肺静脉消融＋线性消融LUPVLLPVRUPVRLPVSCVICVHaissaguerre房颤消融治疗主要的并发症--左房食管瘘--肺静脉狭窄--房性心律失常--心包填塞--脑卒中数天之

2、后才发生不具有特异性胸痛发热惊厥系统性栓塞败血症白细胞升高CRP升高左房食管瘘的识别：临床表现CalkinsH.etal.HeartRhythm2006;10:1162-1163发生率：〉60例(0.05-1%)死亡率：〉75%左房食管瘘的识别：临床表现目前最大病例数报道CummingsJE.etal.AnnInternMed.2006;144:572-574CummingsJE.etal.AnnInternMed.2006;144:572-574CummingsJE.etal.AnnInternMe

3、d.2006;144:572-574CummingsJE.etal.AnnInternMed.2006;144:572-574PreisO.JThoracImaging2007;22:283-285左房食管瘘的识别：影像特征PreisO.JThoracImaging2007;22:283-285PreisO.JThoracImaging2007;22:283-285PreisO.JThoracImaging2007;22:283-285MalamisAP.JThoracImaging2007;22:1

4、88-191MalamisAP.JThoracImaging2007;22:188-191SchleyP.Europace2006;8189-190SchleyP.Europace2006;8189-190SchleyP.Europace2006;8189-190左房食管瘘的诊断与处理当怀疑本病存在时，即禁忌行内窥镜以及食管内超声等检查。推荐行无创检查，如CT,MRI增强检查。一经发现，立即手术。肺静脉、左房和食管的解剖关系AnatomicRelationshipoftheEsophagusandLe

5、ftAtriumTsaoHMChest.2005;128:2581-2587AlthoughtheanatomicrelationshipbetweentheesophagusandLAposteriorwallvariedwidely,twomajorpatternsofesophagealroutescouldbedepictedSanchez-QuintanaD,etal.Circulation.,2005;112:1400-5AnatomicRelationshipoftheEsophagus

6、andLeftAtriumSanchez-QuintanaD,etal.Circulation.,2005;112:1400-5AnatomicRelationshipoftheEsophagusandLeftAtriumSanchez-QuintanaD,etal.Circulation.,2005;112:1400-5AnatomicRelationshipoftheEsophagusandLeftAtriumSanchez-QuintanaD,etal.Circulation.,2005;112

7、:1400-5AnatomicRelationshipoftheEsophagusandLeftAtriumSanchez-QuintanaD,etal.Circulation.,2005;112:1400-5AnatomicRelationshipoftheEsophagusandLeftAtrium左房食管瘘的预防--了解食管走形食管造影CT,MRI，心内超声（ICE）CARTO-Merge,Navix--放电前食管标测--食管内温度监测--低能量输出--不同能源：冷凝--食管内冷盐水灌注球囊预防

8、与对策术前影像检查－了解食管走形食管造影GoodE.JACC2005;46:2107-2110GoodE.JACC2005;46:2107-2110≥2cm67%≥4cm4%GoodE.JACC2005;46:2107-2110实时检测食道的位置更为重要GoodE.JACC2005;46:2107-2110CARTO-MergeNavix改变消融策略Pappone:左房后壁温度低于55°C射频能量应低于50W左房消融线应移至左房顶壁Ren:临近食管处温度