Aerodigestive tract perforation following transesophageal echocardiogram

Abstract

Objectives: Aerodigestive tract perforation following transesophageal echocardiogram transesophageal echocardiogram (TEE) is routinely used as a method to assess cardiac hemodynamics intraoperatively. The safety of this modality has been well established. However, life-threatening complications can occur. Perforation of the orogastric pathway occurs in less than 0.008% of patients, yet the mortality associated with this complication is 42%. Consequently, physicians must possess the ability to recognize and appropriately manage this complication. We describe a case of hypopharyngeal perforation following intraoperative insertion of a TEE probe and review the English-language literature regarding this condition. Transesophageal echocardiography performed intraoperatively is associated with a slightly higher incidence of perforation. Postoperative symptoms are often vague and diagnosis can be delayed. This results in significant morbidity and mortality. We discuss identification of risk factors, diagnosis, and treatment protocols for hypopharyngeal perforation following TEE. Methods: We reviewed the English-language literature regarding hypopharyngeal perforation following intraoperative insertion of a TEE probe. Results: Perforation of the orogastric pathway occurs in less than 0.008% of patients undergoing intraoperative TEE. Conclusion: Although the incidence of orogastric perforation following intraoperative TEE is rare, significant mortality is associated with this complication. Thus, clinicians must be aware of this complication to prevent delay in diagnosis.