Forgut Injuries as a Complication of Transesophageal Echocardiography in Patients Undergoing Cardiac Surgery
Frank Manetta1, Sophia L. Dellis2, Pey-Jen Yu2, 1Hofstra-North Shore LIJ School of Medicine, Bay Shore, NY, 2Hofstra-North Shore LIJ School of Medicine, Manhasset, NY
OBJECTIVE: Transesophageal echocardiography is routinely used in cardiac surgery. Although it is considered a benign procedure, complications can occur. We sought to describe the incidence and presentation of these complications.
METHODS: A retrospective review of cases from a prospective cardiac database was performed on 6,133 cardiac surgery patients. We identified 15 of the 6,133 surgical patients who experienced adverse events of the esophagus or foregut related to TEE. Patient data were extracted from the New York State Cardiac Surgery database, New York STS database, and M&M reports.
RESULTS: The total rate of pharyngeal/upper gastrointestinal injuries from TEE was 15 in 6,133 (0. 2%). 100% of patients presented with upper GI bleeding. 27% of patients had difficult probe placement; . 20% of procedures led to perforations of the pharynx, esophagus, and gastroesophageal junction. 73% of injuries were limited to the esophageal mucosa and were managed with irrigation, clips, medication, or surgery. 73% of patients underwent esophagogastroduodenoscopy and 47% underwent a barium swallow. In one-third of cases there was a delay (1-11 days) in diagnosis of the injury. Length of stay ranged from 8 days to 116 days; there was one operative mortality.
CONCLUSIONS: Injuries associated with blind placement of the transesophageal probe in patients undergoing cardaic surgery are rare. The most common presenting sign is upper gastrointestinal bleeding. A high index of suspicion is waranted to make the diagosis. EGD should be considered to rule out injury in patients who have upper gastrointestinal bleeding after TEE.