Esophageal Perforation, Trauma & Disorders


E-chocardiography Journal: Alphabetical List / Chronological List / Images / Home Page


J Heart Lung Transplant. 2004 Apr;23(4):509-11.
Acute esophagoarterial perforation and hemorrhagic shock during transesophageal echocardiography that occurs after heart-lung transplantation.
Kerbaul F, Renard S, Guidon C, Gouin F, Villacorta J, Collart F, Mouly-Bandini A, Kreitmann B, Metras D, Ville E, Doddoli C.


Dtsch Med Wochenschr. 2004 Apr 30;129(18):1006-8.
Iatrogenic perforation of the esophagus during transesophageal echocardiography. A rare cause of severe dysphagia]
Trinh TT, Kneist W, Oberholzer K, Junginger T.
Klinik und Poliklinik fur Allgemein- und Abdominalchirurgie der Johannes Gutenberg-Universitat Mainz.

HISTORY: A 65-year-old patient underwent transesophageal echocardiography which caused a perforation of the upper esophagus. Three months after esophagostomy and gastrostomy the reconstruction was accomplished by a colon interposition graft. The patient p ostoperatively developed an ischemic necrosis of the graft, followed by a cervical fistula. Food intake and swallowing became impossible. DIAGNOSIS: X-ray examinations revealed the cervical fistula and a stenotic colon graft. TREATMENT AND COURSE: The ret rosternal colon graft was replaced by a gastric interposition graft, which was anastomosed with the cervical esophagus. The postoperative follow-up was normal at first. Increasing retention of secretion in the remaining esophagus however caused dilatation and a cervival fistula again, as well as a pleural empyema. After transthoracic resection of the esophagus the patient was finally free of symtoms, and gained weight on unrestricted food intake. CONCLUSION: Transesophageal echocardiography is a common di agnostic procedure with a low complication rate. Even though serious complications may occur in rare cases, the patient must be informed about the risk. The perforation of the esophagus is an emergency situation that requires surgical treatment immediatel y. Primary reconstruction and preservation of the esophagus is the recommended strategy.


Laryngoscope. 2004 May;114(5):821-6.
Hypopharyngeal perforation near-miss during transesophageal echocardiography.
Aviv JE, Di Tullio MR, Homma S, Storper IS, Zschommler A, Ma G, Petkova E, Murphy M, Desloge R, Shaw G, Benjamin S, Corwin S.
Department of Otolaryngology-Head and Neck Surgery, Columbia University Medical Center, New York-Presbyterian Hospital, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA. jea10@columbia.edu

OBJECTIVES/HYPOTHESIS: The traditional blind passage of a transesophageal echocardiography probe transorally through the hypopharynx is considered safe. Yet, severe hypopharyngeal complications during transesophageal echocardiography at several institutio ns led the authors to investigate whether traditional probe passage results in a greater incidence of hypopharyngeal injuries when compared with probe passage under direct visualization. STUDY DESIGN: Randomized, prospective clinical study. METHODS: In 15 9 consciously sedated adults referred for transesophageal echocardiography, the authors performed transesophageal echocardiography with concomitant transnasal videoendoscopic monitoring of the hypopharynx. Subjects were randomly assigned to receive tradit ional (blind) or experimental (optical) transesophageal echocardiography. The primary outcome measure was frequency of hypopharyngeal injuries (hypopharyngeal lacerations or hematomas), and the secondary outcome measure was number of hypopharyngeal contac ts. RESULTS: No perforation occurred with either technique. However, hypopharyngeal lacerations or hematomas occurred in 19 of 80 (23.8%) patients with the traditional technique (11 superficial lacerations of pyriform sinus, 1 laceration of pharynx, 12 ar ytenoid hematomas, 2 vocal fold hematomas, and 1 pyriform hematoma) and in 1 of 79 patients (1.3%) with the optical technique (superficial pyriform laceration) (P =.001). All traumatized patients underwent flexible laryngoscopy, but none required addition al intervention. Respectively, hypopharyngeal contacts were more frequent with the traditional than with the optical technique at the pyriform sinus (70.0% vs. 10.1% [P =.001]), arytenoid (55.0% vs. 3.8% [P =.001]), and vocal fold (15.0% vs. 3.86% [P =.01 6]). CONCLUSION: Optically guided trans-esophageal echocardiography results in significantly fewer hypopharyngeal injuries and fewer contacts than traditional, blind transesophageal echocardiography. The optically guided technique may result in decreased frequency of potentially significant complications and therefore in improved patient safety.


Anesth Analg. 2004 Jul;99(1):41-4.
Late presentation of esophageal injury after transesophageal echocardiography.
MacGregor DA, Zvara DA, Treadway RM Jr, Ibdah JA, Maloney JD, Kon ND, Riley RD.
Department of Anesthesia, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1009, USA. dmacg@wfubmc.edu

Esophageal injury is a rare complication of intraoperative transesophageal echocardiography (TEE) associated with cardiac surgery. We report two cases of delayed presentation (2 and 6 days after surgery) of esophageal injury that were likely due to TEE. T he differential diagnosis of postoperative pleural effusion or anemia must include esophageal injury from TEE, even 6 days after the procedure.


J Clin Gastroenterol. 2004 Aug;38(7):581-5.
Primary endoscopic management of esophageal perforation following transesophageal echocardiogram.
Sobrino MA, Kozarek R, Low DE.
Department of Surgery, Virginia Mason Medical Center, Seattle, WA 98111, USA.

A 90-year-old woman sustained a proximal esophageal perforation following transesophageal echocardiography. The perforation originated at the site of a Zenker's diverticulum and resulted in a false passage to the diaphragm. Initial management involved end oscopic placement of drains into the mediastinum in addition to bilateral chest drains and a gastrostomy. Following stabilization, the patient had repair of her Zenker's diverticulum and recovered uneventfully. We recommend that all procedures involving b lind intubation of the esophagus should be preceded with specific pursuit of a background of cervical dysphagia.


Chir Ital. 2003 Jan-Feb;55(1):113-8.
Treatment of esophageal perforations. Considerations on a clinical case
Catani M, De Milito R, Chiaretti M, Capitano S, Battillocchi B, Vermeil V, Frattaroli S, Toccaceli S, Negro P.
Dipartimento di Chirurgia Generale, Specialita Chirurgiche e Trapianti d'Organo Paride Stefanini, Universita degli Studi di Roma La Sapienza.

The Authors describe a rare case of esophageal perforation occurred after Transoesophageal echocardiography in 68 years old patient and review the literature relating to the causes and management of this pathology. Transoesophageal echocardiography, which is a semi-invasive investigation increasingly used in cardiology and cardiac surgery and intensive care units, is a rare though extremely dangerous cause of such complications. Perforation of the esophagus continues to present a formidable diagnostic and therapeutic challenge. The diagnosis depends on a high degree of suspicion and on the recognition of clinical features and is confirmed by contrast esophagography. The outcome after esophageal perforation depends on the location of the injury, the presen ce or otherwise of concomitant esophageal disease and the time elapsing between the injury and inititian of treatment. Reinforced primary repair of the perforation is the procedure most frequently employed and preferred for the surgical management of the esophageal perforation. In the case reported here, early diagnosis and prompt surgical treatment consisting in primary repair of the esophageal perforation contributed to the successful management of this serious pathology.


Circ J. 2003 Apr;67(4):357-8.
Mallory - weiss tear complicating intraoperative transesophageal echocardiography.
Fujii H, Suehiro S, Shibata T, Aoyama T, Ikuta T.
Division of Cardiovascular Surgery, Second Department of Surgery, Osaka City University Medical School, Japan. fujiihiro@msic.med.osaka-cu.ac.jp

A Mallory - Weiss tear occurred as a complication of intraoperative transesophageal echocardiography carried out in a 62-year-old man who underwent coronary artery bypass grafting. Left ventricular function was monitored in the transgastric short-axis vie w. Postoperative esophagogastroscopy revealed a Mallory - Weiss tear at the gastroesophageal junction and erosions in the cardia, presumably secondary to contact pressure by the echoprobe and ultrasonic thermal injury. When not actively imaging, the echop robe should be left free in the esophagus with the acoustic power off.


Acta Anaesthesiol Sin. 2003 Jun;41(2):81-4.
Delayed diagnosis of esophageal perforation following intraoperative transesophageal echocardiography during valvular replacement--a case report.
Han YY, Cheng YJ, Liao WW, Ko WJ, Tsai SK.
Department of Anesthesiology, I-Lan Hospital, I-Lan, Taiwan, R.O.C.

A 62 year-old man sustained esophageal perforation following intra-operative transesophageal echocardiography (TEE) in a valvular replacement surgery. Septic shock developed on the 12th postoperative day (POD) and the esophageal perforation was diagnosed with chest CT. Emergent operation together with intensive care saved the patient's life. We speculate that the mechanism of perforation was not due to manipulation of the probe, but rather due to ischemia of the esophagus resulting from the combination of probe compression, non-pulsatile flow and the distension of the atria during a lengthy procedure. It is advisable that in patients with operative risk factors, such as distension of atria, long cardiac procedure and likely ischemia of organs due to cardi opulmonary bypass, the monitoring probe of TEE should not constantly rest in the esophagus and be withdrawn when it is idle or not in actual use. In addition, if resistance has been met during the intraoperative manipulation of the probe in a patient with out previous history of esophageal disease, perforation might suspected if he or she sustains postoperative fever with positive chest X-ray findings.


Ann Thorac Surg. 2003 Jun;75(6):1955-7.
Esophageal perforation by echoprobe during cardiac surgery: treatment by endoscopic stenting.
Nana AM, Stefanidis C, Chami JP, Deviere J, Barvais L, De Smet JM.
Department of Cardiac Surgery, Erasme Hospital, University of Brussels, Brussels, Belgium.

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 case of es ophageal perforation by echoprobe during coronary artery bypass grafting treated successfully by endoscopic stenting is reported.


Acta Anaesthesiol Sin. 2003 Sep;41(3):155-8.
Unusual cause of esophageal perforation during intraoperative transesophageal echocardiography monitoring for cardiac surgery--a case report.
Pong MW, Lin SM, Kao SC, Chu CC, Ting CK, Tsai SK.
Department of Anesthesiology, National Yang-Ming University, Taipei-Veterans General Hospital, Taipei, Taiwan, R.O.C.

Although esophageal perforation after transesophageal echocardiographic (TEE) examination is rare yet the occurrence of this life-threatening complication is increasing. We report an unusual esophageal perforation occurring 4 days after coronary artery by pass graft surgery and Bentall's procedure. The perforation was due to inadvertent injury of the esophagus that was deformed and distorted by a large calcified lymph node in the mediastinum during intraoperative TEE instrumentation. We suggest that carefu l preoperative radiological examination of the mediastinum should be done to recognize the anatomical pathology in patient whose routine chest X-ray has disclosed a large calcified lymph node in the mediastinum, if he happens to undergo TEE, so as to avoi d disastrous esophageal perforation.


Ann Thorac Surg. 2003 Nov;76(5):1450-6.
The incidence of dysphagia in pediatric patients after open heart procedures with transesophageal echocardiography.
Kohr LM, Dargan M, Hague A, Nelson SP, Duffy E, Backer CL, Mavroudis C.
Division of Cardiovascular-Thoracic Surgery, Department of Speech and Language Pathology, Children's Memoiral Hospital, Chicago, Illinois, USA.

BACKGROUND: Pediatric patients who undergo open heart operations may be at risk for the development of dysphagia because of interventions such as intubation and transesophageal echocardiography. Although the occurrence of dysphagia after cardiac surgical procedures in adults is reported to be 3% to 4%, the incidence in children and adolescents has not been documented. This study was undertaken to determine the incidence of and risk factors contributing to dysphagia in pediatric patients after open heart p rocedures. METHODS: Fifty patients were evaluated after open heart operations with transesophageal echocardiography between March 1, 1999, and September 30, 1999. The diagnosis of dysphagia was made by a speech pathologist using a clinical swallowing eval uation. Potential predictors examined included demographic variables, anatomical diagnosis, surgical procedure, size of the transesophageal echocardiographic probe in relation to body size, length of probe insertion time, preoperative patient acuity statu s, duration of intubation, and time until discharge. RESULTS: Dysphagia was found in 9 (18%) of the 50 patients. Risk factors identified were age of less than 3 years (odds ratio, 20.4; 95% confidence interval, 2.7 to 157; p = 0.002), intubation prior to operation (odds ratio, 17.7; 95% confidence interval, 9.4 to 210; p = 0.004), intubation for more than 7 days (odds ratio, 74.7; 95% confidence interval, 13.8 to 405; p = 0.001), and operation for left-sided obstructive lesions (odds ratio, 1.9; 95% confi dence interval, 2.2 to 8.3; p = 0.038). The size of the transesophageal echocardiographic probe in relation to the weight of the patient was found to be predictive (p = 0.0001) of dysphagia. Vocal cord paralysis was noted in 4 (8%) of the 50 patients post operatively. Adverse events related to aspiration occurred in 2 patients (4%). At discharge, nasogastric tube feedings were required in 6 patients (12%), and thickened feedings were recommended for 3 (6%) of the 50 patients. Resolution of dysphagia ranged from 13 to 150 days. CONCLUSIONS: Eighteen percent of patients had dysphagia after an open heart operation with transesophageal echocardiography. Age of less than 3 years, preoperative patient acuity status, longer intubation times, and operation for lef t-sided obstructions are risk factors for dysphagia in this cohort of pediatric patients. The size of the transesophageal echocardiography probe in relation to the patient's weight was predictive of dysphagia. Physicians should consider using the new mini -multiplane transesophageal echocardiographic probes in patients weighing less than 5.5 kg. Vigilance in monitoring for the signs of preoperative and postoperative dysphagia with prompt referral to a speech therapist can substantially reduce patient morbi dity, length of hospital stay, and requirement of prolonged nasogastric tube use.


HNO. 2003 Nov;51(11):903-7. Epub 2003 Apr 9.
Undetected hypopharyngeal perforation with deep neck abscess and mediastinitis due to transesophageal echocardiography
Eichhorn KW, Bley TA, Ridder GJ.
Universitatsklinik fur Hals-, Nasen- und Ohrenheilkunde und Poliklinik, Universitatsklinikum Freiburg.

Hypopharyngeal perforation is a rare but dangerous complication caused by diagnostic procedures. If there is any suspicion of perforation of the upper airways and/or upper digestive tract, immediate diagnostic and therapeutic procedures are indicated. Pos sible complications of a hypopharyngeal perforation are deep neck infection with subsequent mediastinitis and haemorrhage from major cervical vessels, both of which have high mortality rates. We present the case of a 65 year old male patient with perforat ion of the hypopharynx after transesophageal echocardiography which was unrecognized for more than 1 week. Clinical symptoms of hypopharyngeal perforation may initially be unspecific. Esophagography (Gastrografin administration) and computed tomography as well as esophagoscopy are needed to certify the diagnosis and to evaluate the extent of the lesion. Pathological findings as well as diagnostic and therapeutic needs are demonstrated and discussed.


Br J Anaesth. 2002 Apr;88(4):595-7.
Late oesophageal perforation after intraoperative transoesophageal echocardiography.
Zalunardo MP, Bimmler D, Grob UC, Stocker R, Pasch T, Spahn DR.
Department of Anaesthesiology, University Hospital Zurich, Switzerland.

Serious haemodynamic instability occurred during emergency surgery for a perforated duodenal ulcer in a 72-year-old man with acute myocardial infarction. Intraoperative transoesophageal echocardiography was crucial for diagnosis of the location of myocard ial infarction in the right ventricle and the subsequent haemodynamic management. Postoperatively, a thrombus in the right coronary artery was removed by coronary angiography. The patient's trachea was extubated on the fourth postoperative day. Another 4 days later a leak in the lower oesophagus was suspected because of pleural empyema, and verified. The patient's trachea had to be re-intubated and an oesophageal stent was inserted. The patient was discharged, fully recovered, 2 months after the operation .


Ann Fr Anesth Reanim. 2002 Apr;21(4):310-4.
A new case of perforation of the esophagus during intraoperative transesophageal echocardiography
Law-Koune JD, Fischler M.
Service d'anesthesie, hopital Foch, 92151 Suresnes, France.

We describe a novel case of peroperative oesophageal perforation following insertion of a transoesophageal echocardiography probe. Histories of left pneumonectomy and oesophageal fragility probably explained this complication. The perforation was stitched and the coronary artery bypass graft surgery was delayed by a few days. Early postoperative period was not marked by infectious complication but the patient could not weaned from ventilatory support. She died 6 months later.


Asian Cardiovasc Thorac Ann. 2002 Mar;10(1):87-8.
Esophageal perforation caused by a blister-wrapped tablet.
Gupta NM, Gupta V, Gupta R, Sudhakar V.
Department of Surgery, Postgraduate Institute of Medical Education and Research Chandigarh, Punjab, India. medinst@pgi.chd.nic.in

An 84-year-old man was diagnosed with esophageal perforation following ingestion of a blister-wrapped tablet. His condition improved after 2 weeks of conservative treatment using antibiotics and high-protein enteral nutrition.


Br J Anaesth. 2002 Apr;88(4):592-4.
Oesophagotracheal perforation after intraoperative transoesphageal echocardiography in cardiac surgery.
Lecharny JB, Philip I, Depoix JP.
Service d'Anesthesiologie et Reanimation Chirurgicale, Hopital Bichat-Claude Bernard, Paris, France.

Although transoesophageal echocardiography (TOE) can be considered a safe procedure, severe complications may occur. We report an oesophagotracheal perforation diagnosed 7 days after a complex and very long four-valve replacement procedure in a patient wi th a poor preoperative condition. We believe that an ischaemic lesion of the oesophagotracheal wall caused by the TOE probe was the initial event leading to this perforation. This observation raises concerns about the safety of prolonged TOE monitoring an d suggests that a combination of risk factors (i.e. a small stature, a very long procedure, congestive heart failure, and a low cardiac output before and after cardiopulmonary bypass) may warrant increased precautions while performing TOE during cardiac s urgery.


Ann Fr Anesth Reanim. 2002 Apr;21(4):310-4.
A new case of perforation of the esophagus during intraoperative transesophageal echocardiography
Law-Koune JD, Fischler M.
Service d'anesthesie, hopital Foch, 92151 Suresnes, France.
We describe a novel case of peroperative oesophageal perforation following insertion of a transoesophageal echocardiography probe. Histories of left pneumonectomy and oesophageal fragility probably explained this complication. The perforation was stitched and the coronary artery bypass graft surgery was delayed by a few days. Early postoperative period was not marked by infectious complication but the patient could not weaned from ventilatory support. She died 6 months later.


Chest. 2002 Nov;122(5):1857-8.
Esophageal perforation associated with noninvasive ventilation: a case report.
Van de Louw A, Brocas E, Boiteau R, Perrin-Gachadoat D, Tenaillon A.
Service de reanimation polyvalente, Hopital Louise Michel, Centre Hospitalier Sud Francilien, Evry Cedex, France. a.vandelouw@infonie.fr
Noninvasive positive-pressure ventilation (NIPPV) is widely used to treat acute respiratory failure, the goal being to avoid exposing patients to the morbidity associated with tracheal intubation. NIPPV may reduce the rates of intubation, morbidity, and m ortality in selected patient subgroups. Although time-consuming for physicians and nurses, NIPPV is fairly easy to use, and few severe complications have been reported. Esophageal perforation is a well-recognized complication of tracheal intubation but ha s not been described in association with NIPPV. We report a case of fatal esophageal perforation associated with NIPPV after a surgical procedure.


J Am Soc Echocardiogr. 2001 Jul;14(7):747-9.
Unrecognized esophageal perforation in a neonate during transesophageal echocardiography.
Muhiudeen-Russell IA, Miller-Hance WC, Silverman NH.
Department of AnesthesiaUniversity of California, San Francisco, USA.

Esophageal perforation caused by transesophageal echocardiography in an infant is believed to be extremely rare. If unrecognized, serious morbidity can result. We report a case of pharyngeal perforation in a neonate undergoing an interrupted aortic arch r epair.


Br J Anaesth. 2000 May;84(5):643-6.
Oesophageal perforation following perioperative transoesophageal echocardiography.
Massey SR, Pitsis A, Mehta D, Callaway M.
Sir Humphry Davy Department of Anaesthesia, Bristol Royal Infirmary, UK.

Transoesophageal echocardiography (TOE) is being used more often by cardiothoracic anaesthetists for the perioperative management of cardiac problems. Reports of iatrogenic oesophageal perforation by instrumentation of the oesophagus are increasing. Altho ugh TOE is considered safe, it may be more risky during surgery, because the probe is passed and manipulated in an anaesthetized patient. It may be in place for several hours so the risk of mucosal pressure and thermal damage is increased. Patients on car diopulmonary bypass are also fully anticoagulated. We describe a case of oesophageal perforation following insertion of the TOE probe in a patient with gross cardiomegaly. Oesophageal distortion by cardiac enlargement may increase the risk of oesophageal perforation. Difficulty in passage of the TOE probe should be regarded with suspicion and withdrawal should be contemplated because the symptoms of oesophageal perforation are often delayed and non-specific. Delay in investigation, diagnosis and treatment will increase morbidity and mortality.


Echocardiography. 2000 Jul;17(5):447-9.
A technique for performing transesophageal echocardiography in patients with Zenker's diverticulum. >BR> Wells GL, Gilliam J, Kitzman DW.
Section of Cardiology, Department of Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045, USA.

A patient with a large Zenker's diverticulum and narrow, angulated passageway successfully underwent transesophageal echocardiography using a pediatric endoscope, short esophageal overtube, and a pediatric transesophageal echocardiographic probe.


Arch Mal Coeur Vaiss. 2000 Oct;93(10):1235-7.
Esophageal perforation during transesophageal echocardiography
Jougon J, Gallon P, Dubrez J, Velly JF.
Service de chirurgie thoracique, MHL hopital du Haut-Leveque, CHU de Bordeaux, Pessac.

Known for its reliability, transoesophageal echocardiography is an investigation which is increasingly used in cardiology, cardiac surgery and intensive care units. It is a semi-invasive investigation of which oesophageal perforation is a very rare but se rious complication. Two cases of oesophageal perforation after transoesophageal echocardiography are reported out of a series of 87 oesophageal perforations treated between January 1981 and February 1999. In both cases, transoesophageal echocardiography w as performed in conscious patients without known pre-existing oesophageal pathology. The presentations were acute. Both patients underwent emergency surgery. One patient is alive and the other one died one month after a second operation related to the per foration. Nine cases of oesophageal perforation have been reported after transoesophageal echocardiography. The pathogenesis, means of prevention and treatment of oesophageal perforation are discussed.


Arch Mal Coeur Vaiss. 2000 Oct;93(10):1235-7.
Esophageal perforation during transesophageal echocardiography
Jougon J, Gallon P, Dubrez J, Velly JF.
Service de chirurgie thoracique, MHL hopital du Haut-Leveque, CHU de Bordeaux, Pessac.

Known for its reliability, transoesophageal echocardiography is an investigation which is increasingly used in cardiology, cardiac surgery and intensive care units. It is a semi-invasive investigation of which oesophageal perforation is a very rare but se rious complication. Two cases of oesophageal perforation after transoesophageal echocardiography are reported out of a series of 87 oesophageal perforations treated between January 1981 and February 1999. In both cases, transoesophageal echocardiography w as performed in conscious patients without known pre-existing oesophageal pathology. The presentations were acute. Both patients underwent emergency surgery. One patient is alive and the other one died one month after a second operation related to the per foration. Nine cases of oesophageal perforation have been reported after transoesophageal echocardiography. The pathogenesis, means of prevention and treatment of oesophageal perforation are discussed.


Br J Anaesth. 1999 Jun;82(6):948-50.
Bleeding from a tear in the gastric mucosa caused by transoesophageal echocardiography during cardiac surgery: effective haemostasis by endoscopic argon plasma coagulation.
Kihara S, Mizutani T, Shimizu T, Toyooka H.
Department of Anaesthesiology, University of Tsukuba, Ibaraki, Japan.

We present an unusual complication of transoesophageal echocardiography (TOE) during cardiac surgery. Although the patient had no oesophageal or gastrointestinal disease, a gastric mucosal tear of approximately 2 cm long occurred in the mucosa just distal to the gastrooesophageal junction caused by the TOE probe. Bleeding from the tear was stopped using endoscopic argon plasma coagulation.


Chest. 1999 Nov;116(5):1247-50.
Endoscopic evaluation of the esophagus in infants and children immediately following intraoperative use of transesophageal echocardiography.
Greene MA, Alexander JA, Knauf DG, Talbert J, Langham M, Kays D, Ledbetter D.
Division of Cardiovascular and Thoracic Surgery, University of Florida Health Science Center, Gainesville, FL, USA. mgreene@health-first.org

OBJECTIVE: Intraoperative transesophageal echocardiography (TEE) has evolved as an essential technique for use during pediatric cardiac surgery; however, few studies have evaluated the safety of TEE in children. This series reports endoscopic examination of the esophagus following intraoperative TEE in pediatric patients. METHODS: Fifty children undergoing congenital heart surgery underwent flexible esophagoscopy that was performed after completion of their heart surgery and after the removal of the trans esophageal echo probe. The patients' ages ranged from 4 days to 10 years old, and their weight ranged from 3.0 to 39.8 kg, with a mean weight of 12.6 kg. RESULTS: Thirty-two of 50 patients (64%) had abnormal results shown on esophageal examinations; this occurred more frequently in the subset of patients weighing < 9 kg. No long-term feeding or swallowing difficulties were noted in any of the 48 patients who survived. CONCLUSIONS: Intraoperative TEE in infants and children frequently caused mild mucosal i njury. Care must be exercised in the insertion and manipulation of the probes.


J Cardiothorac Vasc Anesth. 1999 Feb;13(1):114-5.
When the transesophageal echo probe goes into the trachea.
Ortega R, Hesselvik JF, Chandhok D, Gu F.


J Clin Gastroenterol. 1998 Oct;27(3):267-8.
Submucosal hemorrhage of the esophagus associated with endoscopy in a patient with cervical osteophytes.
Thomson A, Fleischer DE, Epstein B.
Department of Medicine, Georgetown University Medical Center, Washington, DC 20007, USA.

Submucosal hemorrhage of the esophagus is an uncommon complication of endoscopy. It has a characteristic appearance and is most likely to occur in patients with cervical osteophytes. It is important to recognize the lesion so that unnecessary biopsies are not taken and other investigations are limited.


Ann Fr Anesth Reanim. 1994;13(6):850-2.
Esophageal perforation after transesophageal echocardiography
Badaoui R, Choufane S, Riboulot M, Bachelet Y, Ossart M.
Service d'Anesthesiologie, CHU Nord, Amiens.

Transoesophageal echocardiography (TOE) is increasingly used in cardiology, cardiac surgery and intensive care. Its complications are rare. We report a case of perforation of the oesophagus after TOE in a 71-year-old woman, scheduled for an elective aorti c valve replacement. Her medical history included arterial hypertension but no pre-existing oesophageal disease. A Hewlett Packard ultrasound imaging system was used, with a 5 MHz single plane probe. After local anaesthesia, the transducer probe was inser ted into the distal oesophagus, after three attempts, without any apparent incident. A few hours later, the patient complained of acute cervical and dorsal pain. Examination showed severe skin emphysema in of neck, but neither breathing difficulties, nor haemodynamic modifications. The EKG was normal and body temperature at 38.8 degrees C. The opacification of the oesophagus showed a passage of the contrast medium into the mediastinum. Emergency surgical exploration by left cervicotomy showed a perforatio n of 2 to 3 cm of the posterior wall of oesophagus, treated with terminal oesophagostomy and drainage. The pressure by the TOE probe on the oesophagus may explain this perforation. The outcome was uneventful. Although TOE is a semi-invasive technique with a low risks its benefit/risk ratio should be considered in each patients before using it.


J Am Soc Echocardiogr. 1998 Jan;11(1):57-60.
Lack of lung hemorrhage in humans after intraoperative transesophageal echocardiography with ultrasound exposure conditions similar to those causing lung hemorrhage in laboratory animals.
Meltzer RS, Adsumelli R, Risher WH, Hicks GL Jr, Stern DH, Shah PM, Wojtczak JA, Lustik SJ, Gayeski TE, Shapiro JR, Carstensen EL.
Center for Biomedical Ultrasound, University of Rochester, New York, USA.

This study investigated the phenomenon of ultrasonically induced lung hemorrhage in humans. Multiple experimental laboratories have shown that diagnostic ultrasound exposure can cause hemorrhage in the lungs of laboratory animals. The left lung of 50 pati ents (6 women, 44 men, mean age 61 years) was observed directly by the surgeon after routine intraoperative transesophageal echocardiography was performed. From manufacturer specifications the maximum derated intensity in the sound field of the system use d was 186 W/cm2, the maximum derated rarefactional acoustic pressure was 2.4 MPa, and the maximum mechanical index was 1.3. The lowest frequency used was 3.5 MHz. This exposure exceeds the threshold found for surface lung hemorrhage seen on gross observat ion of laboratory animals. No hemorrhage was noted on any lung surface by the surgeon on gross observation. We conclude that clinical transesophageal echocardiography, even at field levels a little greater than the reported thresholds for lung hemorrhage in laboratory animals, did not cause surface lung hemorrhage apparent on gross observation. These negative results support the conclusion that the human lung is not markedly more sensitive to ultrasound exposure than that of other mammals.


J Am Soc Echocardiogr. 1998 May;11(5):491-3.
Unilateral pulmonary edema during transesophageal echocardiography.
Stienlauf S, Witzling M, Herling M, Harpaz D.
Department of Internal Medicine E, The Heart Institute, E. Wolfson Medical Center, Holon, Israel.

Transesophageal echocardiography is considered to be a relatively safe procedure, the complications of which are well known and include probe-related and procedure-related complications. Congestive heart failure rarely occurs. Unilateral pulmonary edema i s relatively uncommon and to the best of our knowledge has never been reported in association with transesophageal echocardiography. Herein we describe an unusual case of unilateral pulmonary edema that developed during the course of transesophageal echoc ardiography.


Surg Today. 1997;27(9):793-800.
The diagnosis and treatment of esophageal perforations resulting from nonmalignant causes.
Mizutani K, Makuuchi H, Tajima T, Mitomi T.
Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan.

Esophageal perforations are extremely difficult to diagnose and treat. We report herein our results of a review of 26 patients with esophageal perforation which were spontaneous in 11, iatrogenic in 11, and caused by a foreign body in 4. Surgical treatmen t was performed in 7 of the patients with spontaneous rupture, but the remaining 19 patients were treated conservatively. The abnormality was found by plain radiography (X-ray) in 22 (85%) of the 26 patients, and by computed tomography (CT) in all 13 pati ents who underwent this procedure. The detection rates by esophagography and esophagoscopy were 100%, or all of 25 patients examined, and 60%, or 9 of 15 patients examined, respectively. Of 12 patients with underlying diseases, 4 (33%) died after the perf oration, whereas only 1 (7%) of 14 patients without any underlying disease died. Postoperative empyema developed in all of 3 patients treated by intraoperative unfixed intrathoracic drainage (UID), but in none of the 4 treated by fixed intrathoracic drain age (FID). Conservative treatment achieved satisfactory results for spontaneous esophageal ruptures confined to the mediastinum, and for iatrogenic perforations and esophageal perforations caused by foreign bodies, provided there was no serious underlying disease such as advanced cirrhosis. Moreover, intraoperative FID proved useful in helping to prevent postoperative empyema.


J Am Soc Echocardiogr. 1997 Nov-Dec;10(9):977-8.
Upper airway obstruction after transesophageal echocardiography.
Saphir JR, Cooper JA, Kerbavez RJ, Larson SF, Schiller NB.
Alta Bates Medical Center, Berkeley, CA 94705-2067, USA.

Although transesophageal echocardiography is considered a generally safe procedure, occasional complications have been reported. Serious esophageal trauma and Mallory Weiss tear have been described, as well as post-transesophageal echocardiography dysphag ia. However, to our knowledge, upper airway and esophageal obstruction have not been previously cited. A case of upper airway obstruction resulting from a transesophageal echocardiography procedure is herein detailed.


Indian J Gastroenterol. 1995 Jan;14(1):29-30.
Spontaneous esophageal perforation: atypical presentation.
Gupta NM, Goenka M, Atri A, Singh R.
Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

A case of spontaneous esophageal perforation occurring in a healthy esophagus without any predisposing factor is reported. The problem of delayed diagnosis has been discussed.


Anesthesiology. 1984 Apr;60(4):353-5.
Air embolism in upright neurosurgical patients: detection and localization by two-dimensional transesophageal echocardiography.
Cucchiara RF, Nugent M, Seward JB, Messick JM.


Back to E-chocardiography Home Page.


The contents and links on this page were last verified on September 17, 2005.