{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T06:14:52Z","timestamp":1778652892892,"version":"3.51.4"},"reference-count":10,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Periprocedural complications of left atrial appendage occlusion (LAAC) are varied and potentially life-threatening. We report a rare case of an iatrogenic esophageal-pleural fistula following a TEE-guided LAAC procedure. A 77-year-old woman with atrial fibrillation and a contraindication to long-term anticoagulation underwent successful LAAC. Her post-operative course was complicated by a pneumothorax and persistent pleural effusion. The diagnosis of an esophageal-pleural fistula was established after analysis of the chest tube drainage revealed food particles. Given her age and active infection, a non-surgical, conservative management strategy was adopted, involving complete gut rest, broad-spectrum antibiotics, thoracic lavage, and enteral nutrition support. The fistula closed after 52\u202fdays of conservative management, confirmed by follow-up imaging. This case underscores that while TEE-related esophageal injury is exceedingly rare, it must be considered in cases of persistent post-procedural pleural effusion. Furthermore, it demonstrates that in selected high-risk patients, a conservative approach can be a viable management option. The decision to perform a pre-procedural upper GI evaluation remains complex, given the very low incidence of this complication.<\/jats:p>","DOI":"10.3389\/fmed.2026.1833714","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T05:55:30Z","timestamp":1778651730000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["An esophageal-pleural fistula following transesophageal echocardiography-guided left atrial appendage closure: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Libin","family":"Qiu","sequence":"first","affiliation":[{"name":"Structural Cardiology Department, Weifang People\u2019s Hospital (The First Affiliated Hospital of Shandong Second Medical University)","place":["Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinpeng","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Weifang People\u2019s Hospital (The First Affiliated Hospital of Shandong Second Medical University)","place":["Weifang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haijing","family":"Fan","sequence":"additional","affiliation":[{"name":"Structural Cardiology Department, Weifang People\u2019s Hospital (The First Affiliated Hospital of Shandong Second Medical University)","place":["Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongxia","family":"Hao","sequence":"additional","affiliation":[{"name":"Department of Arrhythmia, Weifang People\u2019s Hospital (The First Affiliated Hospital of Shandong Second Medical University)","place":["Weifang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European heart rhythm association (EHRA) of the ESC","volume":"42","author":"Hindricks","year":"2020","journal-title":"Eur Heart J"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e022124","DOI":"10.1161\/JAHA.121.022124","article-title":"Periprocedural and short-term outcomes of percutaneous left atrial appendage closure according to type of atrial fibrillation","volume":"10","author":"Isogai","year":"2021","journal-title":"J Am Heart Assoc"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"814","DOI":"10.1016\/j.jaccas.2020.02.025","article-title":"Late presentation of pulmonary artery-left atrial appendage fistula formation after left atrial appendage device closure","volume":"2","author":"Miller","year":"2020","journal-title":"JACC Case Rep"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1016\/j.echo.2022.12.023","article-title":"Complications associated with transesophageal echocardiography in Transcatheter structural cardiac interventions","volume":"36","author":"Hasnie","year":"2023","journal-title":"J Am Soc Echocardiogr"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1111\/anae.14734","article-title":"Complications related to peri-operative transoesophageal echocardiography - 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