Abstract 15302: Successful Transesophageal Echocardiograms in Two Patients With Esophagectomy

Abstract

Clinical Presentation: Case 1: A 74-year-old man was admitted to the ICU with altered mental status and shortness of breath. The patient had a history of esophageal adenocarcinoma and underwent an Ivor-Lewis esophagectomy 5 months prior. Blood cultures grew candida glabrata and the patient was started on an antifungal medication. A transthoracic echocardiogram was done without evidence of infective endocarditis. A transesophageal echocardiogram (TEE) was requested for higher quality imaging of the valves. Case 2: A 57-year-old man with a history of esophageal cancer with an esophagectomy done 4 years prior and atrial fibrillation (AF) presented for recurrence of AF. The patient had been maintained on apixaban and metoprolol but developed melena as well as reoccurrence of AF. An AF ablation was performed and a left atrial ablation appendage closure with a WATCHMAN device was planned for 6 weeks later. A TEE was requested intraoperatively for device guidance. Imaging Findings: In both cases, CT scans of the chest and abdomen within the last 4 months were reviewed to ensure patency of the esophagogastric anastomosis. In case 1, the TEE was performed with our standard scope without complication and showed no gross vegetations or abnormalities. In case 2, the TEE was performed with our standard scope without difficulty and showed a 20 mm x 21 mm x 20 mm left atrial appendage without thrombus. The WATCHMAN device was deployed successfully. Summary and Discussion Points: In our two patient cases, we were able to successfully perform TEE without complication in the setting of prior esophagectomy. Prior esophagectomy has traditionally been considered a barrier for TEE which can lead to limited evaluation and treatment of patients with esophagectomies where a TEE is required. In our cases, we consulted the patients’ surgeons who performed the esophagectomies and analyzed the CT images prior to performing the procedures to ensure the safety and feasibility of performing the TEE.