The Way to Man's Heart Is through the Stomach

Abstract

Organ systems do not exist in a vacuum. However, in an era of increasingly specialized medicine, the focus is often on the organ system alone. Many symptoms are associated with differential diagnoses from upper gastrointestinal (GI) and cardiovascular medical and surgical specialties. Furthermore, a large number of rare but deadly conditions cross paths between the upper GI tract and cardiovascular system; a significant proportion of these are iatrogenic injuries from a parallel specialty. These include unusual fistulae, herniae, and embolisms that transcend specialties. This review highlights these conditions and the shared anatomy and embryology of the two organ systems.

Keyword

anatomy - aneurysm - aorta/aortic - cardiac - esophageal surgery

Publication History

Received: 10 July 2019

Accepted: 17 September 2019

Article published online:
22 November 2019

• References

• 1 Kloesel B, DiNardo JA, Body SC. Cardiac embryology and molecular mechanisms of congenital heart disease – a primer for anesthesiologists. Anesth Analg 2016; 123 (03) 551-569
• 2 Moorman A, Webb S, Brown NA, Lamers W, Anderson RH. Development of the heart: (1) formation of the cardiac chambers and arterial trunks. Heart 2003; 89 (07) 806-814
• 3 Wright VM, Walker-Smither JA. Congenital abnormalities of the gastrointestinal tract. In: Warrell DA, Cox TM, Firth JD. eds. Oxford Textbook of Medicine. Vol 2. Oxford: Oxford University Press; 2010: 2395
• 4 Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014
• 5 Morris T. The Matter of the Heart. London: Bodley Head; 2017
• 6 O'Shaughnessy L. An experimental method of providing a collateral circulation to the heart. Br J Surg 1936; 23 (91) 665-670
• 7 Manisty C, Hughes-Roberts Y, Kaddoura S. Cardiac manifestations and sequelae of gastrointestinal disorders. Br J Cardiol 2009; 16: 175-180
• 8 Smith KS, Papp C. Episodic, postural, and linked angina. BMJ 1962; 2 (5317): 1425-1430
• 9 Serebro HA. The prognostic significance of the viscerocardiac reflex phenomenon. S Afr Med J 1976; 50 (20) 769-772
• 10 Manfrini O, Bazzocchi G, Luati A, Borghi A, Monari P, Bugiardini R. Coronary spasm reflects inputs from adjacent esophageal system. Am J Physiol Heart Circ Physiol 2006; 290 (05) H2085-H2091
• 11 Arif H, Aggarwal S. Salicylic Acid (Aspirin). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018
• 12 Perk J, De Backer G, Gohlke H. et al; European Association for Cardiovascular Prevention & Rehabilitation (EACPR); ESC Committee for Practice Guidelines (CPG). European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 2012; 33 (13) 1635-1701
• 13 Sørensen HT, Mellemkjaer L, Blot WJ. et al. Risk of upper gastrointestinal bleeding associated with use of low-dose aspirin. Am J Gastroenterol 2000; 95 (09) 2218-2224
• 14 Shah NH, LePendu P, Bauer-Mehren A. et al. Proton pump inhibitor usage and the risk of myocardial infarction in the general population. PLoS One 2015; 10 (06) e0124653
• 15 Hoolwerf EW, Kraaijpoel N, Büller HR, van Es N. Direct oral anticoagulants in patients with liver cirrhosis: a systematic review. Thromb Res 2018; 170: 102-108
• 16 Filimon AM, Negreanu L, Doca M, Ciobanu A, Preda CM, Vinereanu D. Cardiovascular involvement in inflammatory bowel disease: dangerous liaisons. World J Gastroenterol 2015; 21 (33) 9688-9692
• 17 Pattanshetty DJ, Anna K, Gajulapalli RD, Sappati-Biyyani RR. Inflammatory bowel “cardiac” disease: point prevalence of atrial fibrillation in inflammatory bowel disease population. Saudi J Gastroenterol 2015; 21 (05) 325-329
• 18 Kristensen SL, Ahlehoff O, Lindhardsen J. et al. Disease activity in inflammatory bowel disease is associated with increased risk of myocardial infarction, stroke and cardiovascular death--a Danish nationwide cohort study. PLoS One 2013; 8 (02) e56944
• 19 Taddio A, Maschio M, Martelossi S, Barbi E, Ventura A. Crohn's disease and Takayasu's arteritis: an uncommon association. World J Gastroenterol 2013; 19 (35) 5933-5935
• 20 Sapru RP, Griffiths PH, Guz A, Eisele J. Syncope on swallowing. Br Heart J 1971; 33 (04) 617-622
• 21 Jervell O, Lødøen O. The gastrocardiac syndrome. Acta Med Scand Suppl 1952; 266: 595-599
• 22 Palmer ED. The abnormal upper gastrointestinal vagovagal reflexes that affect the heart. Am J Gastroenterol 1976; 66 (06) 513-522
• 23 Linz D, Hohl M, Vollmar J, Ukena C, Mahfoud F, Böhm M. Atrial fibrillation and gastroesophageal reflux disease: the cardiogastric interaction. Europace 2017; 19 (01) 16-20
• 24 Takahashi A, Kuwahara T, Takahashi Y. Complications in the catheter ablation of atrial fibrillation: incidence and management. Circ J 2009; 73 (02) 221-226
• 25 Qumseya BJ, Kusumoto F, Wolfsen H. Esophageal injury following left atrial ablation. Gastroenterol Hepatol (N Y) 2012; 8 (06) 414-416
• 26 Rajakulasingam R, Francis R, Ghuran A. A rare complication following radiofrequency ablation. BMJ Case Rep 2013; 2013: 2013
• 27 Babic D, Benussi S, Schwarz U, Valli PV, Matter CM. Endocarditis, hemiparesis, and upper GI bleeding 4 weeks after radiofrequency ablation for atrial fibrillation. Eur Heart J Cardiovasc Imaging 2016; 17 (06) 703
• 28 Chiari H. Ueber Fremdkorpeverletzung des Oesophagus mit Aortenperforation. Berlin Klin Wschr. 1914; 51: 7-9
• 29 Dubreuil. Observations sur la perforation de l'oesophage et de l'aorte thoracique par une potion d'os avale: avec des reflexions. J Univ Sci Med. 1818; 9: 357-363
• 30 Duncan J. Case of fatal hemorrhage from perforation of the aorta by false teeth impacted in the oesophagus. Northern J Med 1844; 1: 15
• 31 Visagan R, Grossman R, Dimitriadis PA, Desai A. ‘Crohn’z meanz Heinz’: foreign body inflammatory mass mimicking Crohn’s disease. Case Reports 2013; 2013: bcr2013009603
• 32 Sloop RD, Thompson JC. Aorto-esophageal fistula: report of a case and review of literature. Gastroenterology 1967; 53 (05) 768-777
• 33 Scher RL, Tegtmeyer CJ, McLean WC. Vascular injury following foreign body perforation of the esophagus. Review of the literature and report of a case. Ann Otol Rhinol Laryngol 1990; 99 (9 Pt 1): 698-702
• 34 Sica GS, Djapardy V, Westaby S, Maynard ND. Diagnosis and management of aortoesophageal fistula caused by a foreign body. Ann Thorac Surg 2004; 77 (06) 2217-2218
• 35 Tezcan O, Oruc M, Kuyumcu M, Demirtas S, Yavuz C, Karahan O. Unexpected complication of oesophagoscopy: iatrogenic aortic injury in a child. Cardiovasc J Afr 2016; 27 (03) e15-e17
• 36 Ikeda Y, Morita N, Kurihara H, Niimi M, Okinaga K. A primary aortoesophageal fistula due to esophageal carcinoma successfully treated with endoluminal aortic stent grafting. J Thorac Cardiovasc Surg 2006; 131 (02) 486-487
• 37 Sivaraman SK, Drummond R. Radiation-induced aortoesophageal fistula: an unusual case of massive upper gastrointestinal bleeding. J Emerg Med 2002; 23 (02) 175-178
• 38 Lee RY, Flaherty L, Khushalani NI. et al. Aorto-esophageal fistula: a rare fatal case caused by esophageal malignancy. J Gastrointest Oncol 2010; 1 (01) 64-65
• 39 Parikh MP, Sherid M, Panginikkod S, Rawal HA, Gopalakrishnan V. Radiation therapy-induced aortoesophageal fistula: a case report and review of literature. Gastroenterol Rep (Oxf) 2016; 4 (02) 165-167
• 40 Siersema PD, Tan TG, Sutorius FF, Dees J, van Blankenstein M. Massive hemorrhage caused by a perforating Gianturco-Z stent resulting in an aortoesophageal fistula. Endoscopy 1997; 29 (05) 416-420
• 41 Unosawa S, Hata M, Sezai A. et al. Surgical treatment of an aortoesophageal fistula caused by stent implantation for esophageal stenosis: report of a case. Surg Today 2008; 38 (01) 62-64
• 42 Schiessel R, Rath T, Kretschmer G. Giant ulcer of the oesophagus with erosion of the aorta- successful treatment with aortic suture secured by an omental graft and oesophagectomy. Br J Surg 1985; 72 (08) 650
• 43 Merendino KA, Emerson EC. Aorto-esophagogastric fistula, an unusual complication of esophagogastrostomy performed under the aortic arch following esophageal resection for carcinoma; a report of two cases. J Thorac Surg 1950; 19 (03) 405-411
• 44 da Silva ES, Tozzi FL, Otochi JP, de Tolosa EM, Neves CR, Fortes F. Aortoesophageal fistula caused by aneurysm of the thoracic aorta: successful surgical treatment, case report, and literature review. J Vasc Surg 1999; 30 (06) 1150-1157
• 45 Born C, Forster A, Rock C, Pfeifer KJ, Rieger J, Reiser M. A case of an upper gastrointestinal bleeding due to a ruptured dissection of a right aortic arch. Cardiovasc Intervent Radiol 2003; 26 (05) 506-509
• 46 Na JY, Kim YS, Choi YD, Kim HS, Park JT. Death by aortoesophageal fistula due to disseminated tuberculosis: a case study. Int J Clin Exp Pathol 2015; 8 (04) 4253-4257
• 47 Funk EH. Aortic aneurysm with esophageal rupture. Med Clin North Am 1918; 2: 795-802
• 48 Sigalet DL, Laberge JM, DiLorenzo M. et al. Aortoesophageal fistula: congenital and acquired causes. J Pediatr Surg 1994; 29 (09) 1212-1214
• 49 Wang N, Sparks SR, Bailey LL. Staged repair using omentum for posttraumatic aortoesophageal fistula. Ann Thorac Surg 1994; 58 (02) 557-559
• 50 Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med 1994; 331 (26) 1729-1734
• 51 Santo KC, Guest P, McCafferty I, Bonser RS. Aortoesophageal fistula secondary to stent-graft repair of the thoracic aorta after previous surgical coarctation repair. J Thorac Cardiovasc Surg 2007; 134 (06) 1585-1586
• 52 Nazarewicz GV, Jain R. Upper gastrointestinal bleeding caused by aortoesophageal fistula. Clin Gastroenterol Hepatol 2016; 14 (12) A22
• 53 Clark A. Ulceration of the oesophagus, opening into the pericardium, caused by swallowing some false teeth. In: Peters JC. ed. Transactions of the New York Pathological Society. Vol. 1. New York: William Wood and Co.; 1854: 227
• 54 Bozer AY, Saylam A, Ersoy U. Purulent pericarditis due to perforation of esophagus with foreign body. J Thorac Cardiovasc Surg 1974; 67 (04) 590-592
• 55 Sharland MG, McCaughan BC. Perforation of the esophagus by a fish bone leading to cardiac tamponade. Ann Thorac Surg 1993; 56 (04) 969-971
• 56 Fukada J, Shigematsu N, Takeuchi H. et al. Symptomatic pericardial effusion after chemoradiation therapy in esophageal cancer patients. Int J Radiat Oncol Biol Phys 2013; 87 (03) 487-493
• 57 Twine CP, Barry JD, Blackshaw GR, Crosby TD, Roberts SA, Lewis WG. Prognostic significance of endoscopic ultrasound-defined pleural, pericardial or peritoneal fluid in oesophageal cancer. Surg Endosc 2009; 23 (10) 2229-2236
• 58 Soler-Soler J, Sagristà-Sauleda J, Permanyer-Miralda G. Management of pericardial effusion. Heart 2001; 86 (02) 235-240
• 59 Nessler B, Paradowski A, Nessler J. et al. [Cardiac tamponade as the first symptom of oesophageal carcinoma -- a case report]. Kardiol Pol 2006; 64 (03) 312-315
• 60 Kaufman J, Thongsuwan N, Stern E, Karmy-Jones R. Esophageal-pericardial fistula with purulent pericarditis secondary to esophageal carcinoma presenting with tamponade. Ann Thorac Surg 2003; 75 (01) 288-289
• 61 Rana ZA, Hosmane VR, Rana NR, Emery DL, Goldenberg EM, Gardner TJ. Gastro-right ventricular fistula: a deadly complication of a gastric pull-through. Ann Thorac Surg 2010; 90 (01) 297-299
• 62 Brullet E, Campo R, Combalía N, Marqués G, Armengol-Miró JR. Gastric ulcer perforation into the heart. Endoscopy 1996; 28 (03) 316-318
• 63 West AB, Nolan N, O'Briain DS. Benign peptic ulcers penetrating pericardium and heart: clinicopathological features and factors favoring survival. Gastroenterology 1988; 94 (06) 1478-1487
• 64 Dhillon A, Eltweri AM, Shah V, Bowrey DJ. Gastropericardial fistula after Roux-en-Y bypass for reflux disease. BMJ Case Rep 2015; 2015: 2015
• 65 Beynon RP, Bahl VK, Prendergast BD. Infective endocarditis. BMJ 2006; 333 (7563): 334-339
• 66 Gould FK, Elliott TS, Foweraker J. et al; Working Party of the British Society for Antimicrobial Chemotherapy. Guidelines for the prevention of endocarditis: report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 2006; 57 (06) 1035-1042
• 67 Breuer GS, Yinnon AM, Halevy J. Infective endocarditis associated with upper endoscopy: case report and review. J Infect 1998; 36 (03) 342-344
• 68 Zhao J. Massive upper gastrointestinal bleeding due to a ruptured superior mesenteric artery aneurysm duodenum fistula. J Vasc Surg 2008; 48 (03) 735-737
• 69 Kim H-C, Oh J-H, Lee Y-C. Esophageal perforation after perioperative transesophageal echocardiography: a case report. J Med Case Reports 2016; 10 (01) 338
• 70 Lennon MJ, Gibbs NM, Weightman WM, Leber J, Ee HC, Yusoff IF. Transesophageal echocardiography-related gastrointestinal complications in cardiac surgical patients. J Cardiothorac Vasc Anesth 2005; 19 (02) 141-145
• 71 Gharzai L, Verma V, Denniston KA, Bhirud AR, Bennion NR, Lin C. Radiation therapy and cardiac death in long-term survivors of esophageal cancer: an analysis of the surveillance, epidemiology, and end result database. PLoS One 2016; 11 (07) e0158916
• 72 Bang YJ, Van Cutsem E, Feyereislova A. et al; ToGA Trial Investigators. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet 2010; 376 (9742): 687-697
• 73 Mohammedi I, Ber C, Peguet O, Ould-Aoudia T, Duperret S, Petit P. Cardiac air embolism after endoscopic retrograde cholangiopancreatography in a patient with blunt hepatic trauma. J Trauma 2002; 53 (06) 1170-1172
• 74 Donepudi S, Chavalitdhamrong D, Pu L, Draganov PV. Air embolism complicating gastrointestinal endoscopy: a systematic review. World J Gastrointest Endosc 2013; 5 (08) 359-365
• 75 Lake E, Puleston J, Farquharson F. Intra-arterial migration of a fractured endoscopic needle. Endoscopy 2017; 49 (S 01): E70-E72
• 76 Reina A, Vidaña E, Soriano P. et al. Traumatic intrapericardial diaphragmatic hernia: case report and literature review. Injury 2001; 32 (02) 153-156
• 77 McCutcheon BL, Chin UY, Hogan GJ, Todd JC, Johnson RB, Grimm CP. Laparoscopic repair of traumatic intrapericardial diaphragmatic hernia. Hernia 2010; 14 (06) 647-649
• 78 Murari VJ, Alexander GL, Cassivi SD. Massive intrapericardial herniation of stomach following pericardial window. Hernia 2004; 8 (03) 273-276
• 79 Docekal J, Fabian T. Pericardial window formation complicated by intrapericardial diaphragmatic hernia. Case Rep Surg 2014; 2014: 132170
• 80 Chin RY, Glew MJ, Brady P. Iatrogenic intrapericardial diaphragmatic hernia. ANZ J Surg 2002; 72 (09) 681-683
• 81 Panday GF, Grandjean JG, Ho KY, Boonstra PW. A rare case of herniation of omentum into the pericardial cavity after using the right gastro-epiploic artery for coronary bypass grafting. Interact Cardiovasc Thorac Surg 2003; 2 (02) 154-155
• 82 Ikeda Y, Tobari S, Morita N, Okinaga K. Strangulated intrapericardial herniation of the stomach after use of the right gastroepiploic artery for coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2005; 4 (03) 168-169
• 83 Tsuneyoshi H, Minami K, Nakayama S, Sakaguchi G. [A case report of gastric perforation after coronary artery bypass grafting with right gastroepiploic artery]. Jpn J Thorac Cardiovasc Surg 1998; 46 (08) 719-723
• 84 Shimizu J, Hirano Y, Kinoshita S, Tatsuzawa Y, Kawaura Y, Takahashi S. Gastric cancer occurred after coronary artery bypass grafting using the right gastroepiploic artery. Ann Thorac Cardiovasc Surg 2004; 10 (04) 255-258
• 85 Konishi Y, Suzuki K, Wada H. et al. How do we manage the gastrectomy for gastric cancer after coronary artery bypass grafting using the right gastroepiploic artery? Report of two cases and a review of the literature. World J Surg Oncol 2007; 5: 54