Abstract
The case of a patient who suffered cardiac arrest while undergoing transesophageal echocardiography (TEE) is presented here. A 75-year-old man with moderate right ventricular (RV) dysfunction and pulmonary hypertension became bradycardic and hypotensive after receiving propofol for procedural sedation. His profound hypotension ultimately led to a pulseless electrical activity (PEA) cardiac arrest. TEE images captured immediately prior to cardiac arrest show a severely dilated and hypokinetic RV, consistent with acute right ventricular failure. This case highlights the potentially fatal consequences of procedural sedation in patients with RV dysfunction and pulmonary hypertension.
Highlights
The sedation administered during transesophageal echocardiography (TEE) can have profound effects on intraprocedural hemodynamics, in patients with underlying right ventricular (RV) dysfunction or pulmonary hypertension
This report demonstrates a case of cardiac arrest during TEE in the setting of RV dysfunction and pulmonary hypertension and briefly reviews TEE-related complications and fatality rates reported in the literature
The sedation administered during TEE poses risks to patients with poor cardiac reserve who are sensitive to minor changes in hemodynamics
Summary
The sedation administered during transesophageal echocardiography (TEE) can have profound effects on intraprocedural hemodynamics, in patients with underlying right ventricular (RV) dysfunction or pulmonary hypertension. Current echocardiographic practice guidelines offer no specific recommendations on whether the performing cardiologist or an anesthesiologist should provide sedation for TEE, which can lead to variable types and levels of sedation during procedures [1]. This report demonstrates a case of cardiac arrest during TEE in the setting of RV dysfunction and pulmonary hypertension and briefly reviews TEE-related complications and fatality rates reported in the literature
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