Abstract
BackgroundEsophageal perforation is a rare but serious complication of transesophageal echocardiography (TEE). An enlarged left atrium (LA), which is commonly associated with mitral stenosis (MS), is an under-recognized risk factor for esophageal perforation after intraoperative TEE.Case presentationWe describe a case of TEE-induced esophageal perforation after cardiac surgery in a 79-year-old woman with a giant LA due to MS. Esophageal perforation was detected on postoperative day 6. After surgical repair, the patient gradually recovered with prolonged conservative treatment. Retrospectively constructed three-dimensional chest computed tomography images revealed an unusually distorted esophagus that was possibly vulnerable to injury.ConclusionA giant LA can markedly distort the esophagus. It should be recognized as a risk factor for TEE-induced esophageal perforation.
Highlights
Esophageal perforation is a rare but serious complication of transesophageal echocardiography (TEE)
We report a case of esophageal perforation after cardiac surgery in a patient with an enlarged left atrium (LA)
NG tube-induced perforation could not be ruled out completely, it was reasonable to think that the perforation was caused by TEE probe based on our observations, the relatively larger perforation size, and the unusually difficult TEE manipulation
Summary
Transesophageal echocardiography (TEE)-related esophageal perforation is a life-threatening complication with an extremely low incidence (0.03 to 0.09%) [1,2,3]. A 79-year-old, 42-kg woman with severe mitral stenosis (MS) was admitted for mitral valve replacement. Preoperative transthoracic echocardiography and TEE showed severe MS, LA enlargement, and a small left ventricular (LV) cavity During TEE examinations after CPB was weaned off, it was again difficult to obtain images in the transgastric short-axis view. Emergent CT detected esophageal perforation just proximal to the esophagogastric junction (EGJ) and migration of the NG tube through the perforation into the mediastinum and abdominal cavity. These findings were confirmed with subsequent upper gastrointestinal endoscopy. She was transferred to another care facility on POD 125
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