Safety Of Transesophageal Echocardiography Research Articles

C-6 | Safety of transesophageal echocardiography in patients referred for tricuspid valve disease prior to structural cardiac interventions

C-6 | Safety of transesophageal echocardiography in patients referred for tricuspid valve disease prior to structural cardiac interventions

Intracardiac vs. transesophageal echocardiography for guiding transcatheter closure of interatrial communications: a systematic review and meta-analysis.

Transcatheter closure of atrial septal defect (ASD) and patent foramen ovale (PFO) is an established practice, and it requires monitoring and guidance. Both transoesophageal echocardiography (TEE) and intracardiac echocardiography (ICE) can be used as guidance tools. However, the use of ICE and TEE in structural heart disease is controversial and the advantages and disadvantages of both for ASD and PFO closure need to be investigated. We did a systematic review and meta-analysis to compare the efficacy and safety of TEE and ICE for guiding transcatheter closure of ASD and PFO. A systematic search of Embase, PubMed, Cochrane library, Web of Science was conducted from inception to May 2022. The outcomes of this study included average time for both fluoroscopy and the procedure, complete closure, length of stay at hospital and adverse events. This study was performed using mean difference (MD), relative risk (RR) and 95% confidence interval (CI). The meta-analysis was conducted with a total of 11 studies, involving 4,748 patients were included in meta-analysis, including 2,386 patients in the ICE group and 2,362 patients in the TEE group. The results of the meta-analysis showed that compared with TEE, ICE was shorter in time both fluoroscopy [MD: -3.72 (95%CI: -4.09 to -3.34) minutes, P < 0.00001] and the procedure [MD: -6.43 (95%CI: -7.65 to -5.21) minutes, P < 0.00001], shorter length of stay at hospital [MD = -0.95 (95% CI = -1.21 to -0.69) days, P < 0.00001], lower incidence of adverse events (RR = 0.72, 95%CI: 0.62 to 0.84, P < 0.0001), and the arrhythmia (RR = 0.50, 95% CI = 0.27 to 0.94, P = 0.03) and vascular complications (RR = 0.52, 95%CI = 0.29 to 0.92, P = 0.02) in ICE group were lower than those in TEE group. No significant difference in complete closure was found between ICE and TEE (RR = 1.00, 95% CI = 0.98 to 1.03, P = 0.74). Under the premise of ensuring successful rate of complete closure, ICE can shorten time between fluoroscopy and procedure and length of stay at hospital, and there was no increase in adverse events. However, more high-quality studies are needed to confirm the benefits of using ICE in ASD and PFO closure.

Safety of transesophageal echocardiography during transcatheter edge-to-edge tricuspid valve repair: A single-center experience.

ObjectivesWe aimed to determine transesophageal echocardiography (TEE) related complications during Transcatheter edge-to-edge tricuspid valve repair (TTVR).BackgroundTransesophageal echocardiography is essential to guide structural heart disease (SHD) interventions. TTVR has become an evolving procedure for high-risk patients not suitable for surgery. Whether this complex procedure is associated with TEE related complications is not known so far.MethodsWe retrospectively analyzed 64 consecutive patients undergoing TTVR between 2019 and 2021 with the TriClip system (Abbott, Chicago, IL, USA) at our center. All procedures were performed under general anesthesia (GA). TEE related complications were classified as major and minor complications.ResultsTransesophageal echocardiography related complications were observed in two patients (3.1%) with one major complication (1.6%) and one minor complication (1.6%). In one patient perforation of the esophageal mucosa requiring red blood cell transfusion was observed, the other patient had hematemesis due to minor esophageal and gastric lesions without the need for blood transfusion. Both patients recovered during hospital stay with no persistent symptoms at discharge.ConclusionsTransesophageal echocardiography related complications during TTVR are clinically relevant occurring in 3.1% of the patients. Further investigations are needed to identify potential risk factors and patients at high risk to develop a TEE related complication in the course of TTVR.

Safety of transoesophageal echocardiography during structural heart disease interventions under procedural sedation: a single-centre study.

The aim of this study was to determine the incidence of transoesophageal echocardiography (TOE)-related adverse events (AEs) during structural heart disease (SHD) interventions and to identify potential risk factors. We retrospectively analysed 898 consecutive patients undergoing TOE-guided SHD interventions under procedural sedation. TOE-related AEs were classified as bleeding complications, mechanical lesions, conversion to general anaesthesia with intubation, and the occurrence of pneumonia. A follow-up was conducted up to 3 months after the intervention. TOE-related AEs were observed in 5.3% of the patients (n = 48). The highest rate of AEs was observed in the percutaneous mitral valve repair (PMVR) group with 8.2% (n = 32), whereas 4.8% (n = 11) of the patients in the left atrial appendage group and 1.8% (n = 5) in the patent foramen ovale/atrial septal defect group developed a TOE-related AE (P = 0.001). The most frequent AE was pneumonia with an incidence of 2.6% (n = 26) in the total cohort. Bleeding events occurred in 1.8% (n = 16) of the patients, mostly in the PMVR group with 2.1% (n = 8). In the multivariate regression analysis, we found a lower haemoglobin {odds ratio (OR) [95% confidence interval (CI)]: 8.82 (0.68-0.98) P = 0.025} and an obstructive sleep apnoea syndrome (OSAS) [OR (95% CI): 2.51 (1.08-5.84) P = 0.033] to be associated with AE. Furthermore, AEs were related to procedural time [OR (95% CI): 1.01 (1.0-1.01) P = 0.056] and oral anticoagulation [OR (95% CI): 1.97 (0.9-4.3) P = 0.076] with borderline significance in the multivariate regression analysis. No persistent damages were observed. TOE-related AEs during SHD interventions are clinically relevant. It was highest in patients undergoing PMVR. A lower baseline haemoglobin level and an OSAS were found to be associated with the occurrence of a TOE-related AE.

The Role of Echocardiography in the Cancer Patient.

To review the uses of echocardiography in patients with cancer and how it has expanded beyond the typical monitoring of systolic function during potentially cardiotoxic cancer therapeutics. In addition to myocardial strain imaging being a predictor of subsequent left ventricular dysfunction, it can be used for pattern recognition to help identify patients with cardiac amyloidosis or Takotsubo cardiomyopathy. Echocardiography is essential for diagnosis and planning of intervention for aortic stenosis in radiation-induced valvular disease, for which transcutaneous aortic valve replacement that gives many cancer patients that are not surgical candidates an option for treatment. The safety of transesophageal echocardiography has recently been demonstrated in patients with cancer with thrombocytopenia and depleted white blood cell counts who are at increased risk of endocarditis. Echocardiography is an essential tool for evaluating common conditions in cancer patients such as pericardial disease, radiation-induced heart disease, and intracardiac tumors-with specific uses of specialized echocardiography techniques such as deformation imaging, transesophageal echocardiography, and point-of-care ultrasound.

Transesophageal echocardiography complications associated with interventional cardiology procedures

Although there have been several reports documenting complications related with transesophageal echocardiography (TEE) manipulation following cardiac surgery, there is a paucity of data regarding the safety of TEE used to guide catheter-based interventions. The aim of this study was to determine the prevalence, types and risk factors of complications associated with procedures requiring active TEE guidance. This study included 1249 consecutive patients undergoing either transcatheter aortic valve implantation (TAVI), Mitraclip, left atrial appendage occlusion (LAAO) or paravalvular leak closure (PVLC). Patients were divided into 2 cohorts based on the degree of probe manipulation required to guide the procedure and the risk of developing a TEE-related complication: low-risk (TAVI, n = 1037) and high-risk (Mitraclip, LAAO and PVLC, n = 212). Patients were further analyzed according to the occurrence of major and minor TEE-related complications. The overall incidence of TEE-related complications was 0.9% in the TAVI group and 6.1% in the rest of the cohort (P < .001). Patients in the high-risk cohort had also a higher incidence of major-complications (2.8% vs 0.6%, P = .008), and factors associated with an increased risk were being underweight, having a prior history of gastrointestinal bleeding and the use of chronic steroids/immunosuppressive medications. Procedural time under TEE-manipulation was longer in patients exhibiting complications and was an independent predictor of major complications (OR = 1.13, 95% CI 1.01-1.25, for each 10 minutes increments in imaging time). Patients with major complications undergoing Mitraclip had the longest median time under TEE-manipulation (297 minutes) and a risk of developing a major-complication that was 10.64 times higher than the rest of the cohort (95% CI 3.30-34.29, P < .001). The prevalence of TEE-related complications associated with interventional procedures is higher than previously reported. Undergoing a prolonged procedure, particularly in the setting of Mitraclip, was the main factor linked to TEE-related complications.

Safety of Transesophageal Echocardiography in Patients with Thrombocytopenia

According to current literature and guidelines, thrombocytopenia is considered a relative contraindication for performing transesophageal echocardiogram (TEE). In cancer patients, thrombocytopenia is frequently present. No prior studies have assessed the safety and complications of TEE in a thrombocytopenic population. From January 2002 to December 2017, all patients who underwent TEE at MD Anderson Cancer Center in the nonoperative setting were included in the study. Patient characteristics, laboratory data, indications, and complications of TEE were obtained from medical records. Thrombocytopenia was defined as platelet count <100,000/μL prior to procedure. In this retrospective study, medical records were reviewed up to 30days after procedure to search for possible complications related to TEE. During the study period, 2,345 TEE studies were performed. The mean age was 58.2±15.3years and 58.8% of patients were male. Thrombocytopenia was found in 814 patients (34.7%). More thrombocytopenic patients had hematologic malignancy, when compared with patients with normal platelet level (79.7% vs 30.2%; P<.001). The most common indication for TEE study was to evaluate for suspected endocarditis (48.0%) and was found more frequently in thrombocytopenic patients compared with those with normal platelet count (69.5% vs 36.5%; P<.001). Overall, 10 patients (0.4%) had complications related to TEE: eight minor oropharyngeal bleeding that did not require transfusion, one transient atrial fibrillation, and one esophageal perforation. There was no major bleeding, respiratory failure, or death related to TEE examination during the study period. Minor oropharyngeal bleeding was the only complication seen in thrombocytopenic patients (seven patients, 0.3%). Thrombocytopenia is common in cancer patients undergoing TEE. TEE-related complications are minimal in patients with both normal or low platelet count. With appropriate patient preparation and careful probe manipulation, TEE can be safely performed in thrombocytopenic patients.

Transoesophageal echocardiography (TOE): contra-indications, complications and safety of perioperative TOE

Transoesophageal echocardiography (TOE) has, in certain clinical situations, become an almost universal monitor and diagnostic tool. In the perioperative environment, TOE is frequently used to guide anaesthetic management and assist with surgical decision making for, but not limited to, cardiothoracic, major vascular and transplant operations. The use of TOE is not limited to the theatre environment being frequently used in outpatient clinics, emergency departments and intensive care settings. Two case reports, one of oesophageal perforation and another of TOE utilization in a patient having previously undergone an oesophagectomy, introduce the need for care while using TOE and highlight the need for vigilance. The safe use of TOE, the potential complications and the suggested contraindications are then considered together with suggestions for improving the safety of TOE in adult and paediatric patients.

Mo2003 - Safety of Transesophageal Echocardiography in Patients with Gastroesophageal Varices

Mo2003 - Safety of Transesophageal Echocardiography in Patients with Gastroesophageal Varices

Safety of transesophageal echocardiography during extracorporeal life support.

Use of extracorporeal life support (ECLS) has significantly increased in critically ill patients refractory to medical management. ECLS requires systemic anticoagulation to avoid thromboembolic complications and superimposed coagulopathies are common. Transesophageal echocardiography (TEE) is frequently employed to assess cannula position and cardiac function during extracorporeal therapy. The goal of this study was to assess whether TEE probe insertion and removal in systemically anticoagulated ECLS patients was safe compared to patients without ECLS and normal coagulation studies. Eighty-seven separate TEE examinations in 53 adult ECLS patients were analyzed. Detailed complication profiles were logged for each patient from initiation through discontinuation of ECLS. Routine coagulation testing was recorded within two hours prior to the TEE exams. Controls consisted of age- and gender-matched patients undergoing perioperative TEE without ECLS and normal coagulation (N=87). Overall TEE-associated morbidity in ECLS patients was 2.3% and consisted of minor oropharyngeal bleeding (2/87 TEE exams) exclusively. The patients presenting with oropharyngeal bleeding received heparin for anticoagulation and had two or more abnormal coagulation studies at the time of TEE. Seventy-nine percent of ECLS patients received intravenous heparin infusions, 6.8% argatroban and 3.4% epoprostenol. Ten-point-eight percent of patients were not anticoagulated at the time of TEE because of pre-existing bleeding complications and/or deranged plasmatic coagulation profiles. No major complications (e.g., esophageal perforation, gastrointestinal bleeding, accidental extubation) were recorded in either group. TEE remained safe in critically ill patients under ECLS, despite systemic anticoagulation, during probe insertion, manipulation and removal. TEE-related complications pertained solely to oropharyngeal bleeding amenable to conservative management.

PM247 Safety of Transesophageal Echocardiography in Severe Thrombocytopenic Patients: A Case Series Study

PM247 Safety of Transesophageal Echocardiography in Severe Thrombocytopenic Patients: A Case Series Study

Clinical research on the application of trans-esophageal echocardiography in monitoring Nuss surgery

To investigate the validity and safety of trans-esophageal echocardiography (TEE) in monitoring of Nuss surgery. A total of 140 patients with pectus excavatum from Sichuan Provincial People's Hospital underwent Nuss surgery from August, 2011 to Aμgust, 2013. Among them, 72 patients received TEE monitoring while 68 patients didn't. The injury of heart and large vessels by the introducer and Nuss steel bar was observed by intraoperative TEE monitoring under middle-esophageal four chamber view and middle-esophageal aortic short axis view. The operation in all patients had been performed successfully without any severe complications. Satisfactory TEE images were obtained in all patients. The procedure of inserting the inducer and Nuss steel bar behind sternum and steel bar overturn could be seen clearly. No injury in heart and large vessels was detected. Local streak-like hemorrhage in 3 patients was observed under intra-operative TEE screen, but no further new bleeding was found in postoperative TEE examination. The blood was absorbed and couldn't see under trans-thoracic echocardiography in 1 month after the operation. The TEE is a non-invasive monitoring method. It is sensitive to detect the status of the heart and large vessels and can prevent the severe complications due to Nuss surgery.

Abstract 15876: The Safety of Transesophageal Echocardiography in Patients With Gastroesophageal Varices

Introduction: The presence of gastroesophageal varices (GEV) is considered a relative contraindication to performing Trans esophageal echocardiography (TEE) however; the safety of TEE in patients with GEV is unknown. Hypothesis: Bleeding complications related to TEE in patients with GEV are dependent on the severity of the GEV. Methods: 55 patients (G1) with GEV undergoing clinically indicated TEE were studied. Each patient was matched by age and gender to a control subject (C). GEV were graded using esophagogastroduodenoscopy (EGD). There were 39 males and 16 females in either group. Complications related to TEE were defined as upper gastrointestinal (GI) bleed, decline in hemoglobin by more than 2 g/dl, esophageal perforation, aspiration, respiratory compromise requiring intubation and/or need for sedative reversal agents that occurred within 48 hours of the procedure. Results: In G1 grade 1, grade 2, and grade 3 GEV were present in 21, 24, and 12 patients, respectively. Of the 12 patients with grade 3 GEV, one patient had GI bleed. TEE findings included vegetation in 8 patients of G1 and in — patients of C and thrombus in 3 patients of G1 and 3 patients of C. Conclusions: TEE appears safe in patient with grade 1 or 2 GEV. However, caution should be advised when performing TEE in patients with grade 3 GEV. TEE showed significant findings of vegetation or thromus in at least 20% of the patients with GEV.

Safety of Transesophageal Echocardiography in Patients with Gastroesophageal Varices

Purpose: Limited data is available on the safety and complications rate of transesophageal echocardiography (TEE) in patients with gastroesophageal varices. This study aims at evaluating the gastrointestinal complications in patients with gastroesophageal varices who had TEE performed and the clinical efficacy of performing upper endoscopy (EGD) prior to TEE in reducing complication rate or altering management plan in this patients' group. Methods: Retrospective database analysis for all patients with known liver cirrhosis with portal hypertension or esophageal varices who underwent TEE between January-2007 and December-2011 in a single center. Data included patient's age, gender, MELD score, Platelets count, INR, grade of varices on most recent EGD, stigmata for risk of bleeding, severity of portal hypertensive gastropathy. Data also included post TEE complications including GI bleeding (a drop in hemoglobin >2 g/dL or a need for blood-product transfusion within 48 hours of TEE), clinical or radiographic evidence of perforation, clinical worsening of hepatic encephalopathy. Data is presented as medians (Interquartile). Results: A total of 20 patients with esophageal varices who underwent TEE were analyzed (12M, 8F), median age 57 years (47-60), MELD score 16 (11-28), platelets count 102 (55-147), INR 1.7 (1.3-2.2). Four patients had history of variceal bleeding in the past with band ligations performed. Most recent EGD in these patients showed grade 2 varices without high risk stigmata. Rest of patients had grade 1 varices. Four patients had severe hypertensive portal gastropathy. Cardiologist requested EGD prior to TEE in 7 patients; three of them never had an EGD before while 2 patients had an EGD at 10 and 12 months, respectively, prior to TEE which showed small varices, their repeat EGD showed similar findings. The other 2 patients had variceal screening before but the duration from their last EGD was unknown. No post TEE complications were reported in the studied patients including no GI bleeding, perforation or worsening encephalopathy. Conclusion: The study suggests that TEE may be a safe procedure if patients had grade 1 or 2 varices on their most recent EGD even if they had variceal bleeding before. An EGD that was performed within the recommended duration interval for variceal screening is likely adequate without a need for a repeat EGD prior to the TEE study. Patients with severe hypertensive portal gastropathy may also have low risk of post TEE complications.

Conservative Management of Iatrogenic Esophageal Perforation During Neonatal Cardiac Surgery

Esophageal perforation is a rare, but life threatening, entity in children. The most common iatrogenic causes include nasogastric tube insertion, stricture dilation, or endotracheal intubation. Recently, transesophageal echocardiography (TEE) has been increasingly used in pediatric cardiac surgery to assess cardiac function and structural abnormalities. The safety of TEE in children is still controversial and complications such as airway obstruction, hemodynamic compromise, and esophageal injury have been reported. We recently experienced a case of esophageal perforation caused by TEE probe insertion during neonatal cardiac surgery; two weeks of conservative management resulted in complete resolution of the injury.

An Unusual Cause of Massive Gastrointestinal Bleeding After Transesophageal Echocardiography

TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) performed by experienced operators has been reported to have an acceptable risk profile. 1 Spier B.J. Larue S.J. Teelin T.C. et al. Review of complications in a series of patients with known gastroesophageal varices undergoing transesophageal echocardiography. J Am Soc Echocardiogr. 2009; 22: 396-400 Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar In 2 large series, the overall morbidity was between 0.18% and 0.2% with only 1 mortality reported in more than 17,000 patients. 2 Kallmeyer I.J. Collard C.D. Fox J.A. et al. The safety of intraoperative transesophageal echocardiography: A case series of 7200 cardiac surgical patients. Anesth Analg. 2001; 92: 1126-1130 Crossref PubMed Scopus (364) Google Scholar , 3 Daniel W.G. Erbel R. Kasper W. et al. Safety of transesophageal echocardiography A multicenter survey of 10,419 examinations. Circulation. 1991; 83: 817-821 Crossref PubMed Scopus (727) Google Scholar The risk of gastrointestinal (GI) bleeding was small. 2 Kallmeyer I.J. Collard C.D. Fox J.A. et al. The safety of intraoperative transesophageal echocardiography: A case series of 7200 cardiac surgical patients. Anesth Analg. 2001; 92: 1126-1130 Crossref PubMed Scopus (364) Google Scholar Indeed, no difference in the incidence of blood in nasogastric aspirates could be found between cardiac patients who had TEE performed and those who did not. 4 Hulyalkar A.R. Ayd J.D. Low risk of gastroesophageal injury associated with transesophageal echocardiography during cardiac surgery. J Cardiothorac Vasc Anesth. 1993; 7: 175-177 Abstract Full Text PDF PubMed Scopus (28) Google Scholar In this context, Spier et al recently argued in favor of using TEE in the setting of known esophageal varices caused by cirrhosis. 1 Spier B.J. Larue S.J. Teelin T.C. et al. Review of complications in a series of patients with known gastroesophageal varices undergoing transesophageal echocardiography. J Am Soc Echocardiogr. 2009; 22: 396-400 Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar Nonetheless, the prospect of using TEE in such high-risk patients, especially those who have been anticoagulated, increases the level of concern in most clinicians. In contrast to TEE's safety record, the authors present a very unusual case of a man with a massive GI bleed after routine TEE, originating from a gastric Dieulafoy lesion. To the authors' knowledge, this is the first such case in the literature.

Safety of Transesophageal Echocardiography in Patients with Known Gastroesophageal Varices: A Case Series

Safety of Transesophageal Echocardiography in Patients with Known Gastroesophageal Varices: A Case Series

Esophageal Stents for Iatrogenic Esophageal Perforations During Cardiac Surgery

The usefulness and safety of transesophageal echocardiography during cardiac surgery have been well described in the literature. However, rare complications of this procedure can occur and should be familiar to surgeons and anesthesiologists. A series of two cases of esophageal perforation by echoprobe during cardiac surgery treated successfully by endoscopic stenting are reported.

The use and safety of transoesophageal echocardiography in the general ICU – a minireview

The efficacy of transoesophageal echocardiography (TEE) has been evaluated predominantly in medical and cardiac surgical ICUs. This article reviews the pertinent literature and evaluates the impact of TEE in a general surgical ICU. Twenty studies on TEE in the ICU were evaluated for complications, indications, diagnostic, therapeutic, and surgical impact on patient management. Diagnostic impact was defined as identification of the underlying cardiovascular pathology, therapeutic impact as changes in patient management and surgical impact as indication for operative procedures. In addition, we reviewed the TEE reports and patient charts of 216 critically ill patients in a 16-bed multidisciplinary surgical ICU at our university hospital, who underwent a TEE for differential diagnosis of hemodynamic instability from July 1995 to December 1998 to assess the impact of TEE on patient management in a general surgical ICU. The diagnostic, therapeutic and surgical impact in a total of 2,508 patients ranged from 44 to 99% (weighted mean 67.2%), 10-69% (36.0%), and 2-29% (14.1%), respectively. The complication rate was 2.6%, with no examination related mortality. In our series in a general surgical ICU, a diagnostic, therapeutic and surgical impact was inferred in 191 (88.4%), 148 (68.5%) and 12 (5.6%) patients, respectively. Adverse effects were observed in 5.6%. TEE is safe, well-tolerated and useful in the management of critically ill patients. This applies as well for hemodynamically unstable patients in a general surgical ICU.

Esophageal mucosal tear from a transesophageal echocardiography probe despite preliminary assessment via esophagoscopy in a patient with esophageal disease

In recent years, transesophageal echocardiography (TEE) has become a common monitoring modality for patients undergoing cardiac surgery. 1 Poterack K.A. Who uses transesophageal echocardiography in the operating room?. Anesth Analg. 1995; 80: 454-458 PubMed Google Scholar TEE is a moderately invasive procedure with a very low rate of complications. Overall morbidity was 0.18% in a multicenter adult series of 10,419 TEE examinations (88.7% of whom were conscious) 2 Daniel W.G. Erbel R. Kasper W. et al. Safety of transesophageal echocardiography. A multicenter survery of 10,419 examinations. Circulation. 1991; 83: 817-821 Crossref PubMed Scopus (727) Google Scholar and 0.2% in a single center adult series of 7200 TEE examinations (all under general anesthesia). 1 Poterack K.A. Who uses transesophageal echocardiography in the operating room?. Anesth Analg. 1995; 80: 454-458 PubMed Google Scholar , 3 Kallmeyer I.J. Collard C.D. Fox J.A. et al. The safety of intraoperative transesophageal echocardiography A case series of 7200 cardiac surgical patients. Anesth Analg. 2001; 92: 1126-1130 Crossref PubMed Scopus (364) Google Scholar Complications include oropharyngeal, hypopharyngeal, esophageal, or esophagotracheal perforation; gastrointestinal bleeding; gastric laceration; dysphagia; or inability to insert the TEE probe. An unusual case is described of the tear of the esophageal mucosa, caused by TEE probe placement in a patient with the history of Schatzki ring and Candida esophagitis, who was scheduled to undergo coronary artery bypass graft (CABG) surgery.