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Review
. 2024 Jul 23;13(15):4291.
doi: 10.3390/jcm13154291.

The Other Side of the Coin: Transesophageal Echocardiography Complications following Cardiac Surgery and Transcatheter Structural Heart Interventions

Valeria Maria De Luca  1 , Valeria Cammalleri  1 , Giorgio Antonelli  1 , Sara Bombace  2 , Tobias Friedrich Ruf  2 , Theresa Ann Maria Gößler  2 , Philipp Lurz  2 , Ralph Stephan von Bardeleben  2 , Francesco Grigioni  1 , Gian Paolo Ussia  1
Affiliations
Review

The Other Side of the Coin: Transesophageal Echocardiography Complications following Cardiac Surgery and Transcatheter Structural Heart Interventions

Valeria Maria De Luca et al. J Clin Med. .

Abstract

Transesophageal echocardiography (TEE) is widely used in cardiac surgery and interventional cardiology and is often an indispensable tool, giving supportive anatomical understanding and smooth guidance in both settings. Despite it being considered safe, fatal complications can commonly occur after a TEE examination in cardiac surgery operating rooms and catheterization laboratories. Currently, there is a lack of awareness of the scale of the problem, as there are only small amounts of data available, mainly derived from the surgical literature. This review summarizes the main predisposing factors for TEE-associated complications (classified as patient and procedure-related) and the main preventive strategies. We aim to apply preventive strategies more broadly, especially to patients at high risk of developing TEE-related serious adverse events.

Keywords: TEE; cardiac surgery; complications; injuries; mitral regurgitation; transcatheter; tricuspid regurgitation.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Transoesophageal probe position (arrow) during transcatheter interventions. (A) The fluoroscopy shows the transgastric probe position during T-TEER. (B) Deep esophageal view used during tricuspid valve replacement. (C) Mid esophageal probe position during LAA occlusion. (D) Mid esophageal probe position used during M-TEER. T-TEER: Tricuspid Transcatheter edge-to-edge repair; LAA: left atrial appendage; M-TEER: Mitral Transcatheter edge-to-edge repair.
Figure 2
Figure 2
ICE application during T-TEER. (A) illustrates the live multiplanar reconstruction process used to align the TriClip (Abbott Vascular, Santa Clara, CA, USA) device on the tricuspid valve, for grasping the anterior and septal leaflets. In (B), the fluoroscopic position of the intracardiac probe can be observed (red arrow). The proximity of the probe to the device allows us to overcome shadows by obtaining high-quality images. T-TEER: Tricuspid Transcatheter edge-to-edge repair; ICE: intracardiac echocardiography.
Figure 3
Figure 3
The EchoNavigator® (Philips Medical System, Andover, MA, USA) live image guidance. The smart fusion technology simplifies visualization by fusing real-time X-rays and live echo. EchoNavigator may give interventionalists a supportive anatomical understanding and smooth guidance during structural heart disease interventions to reduce the time undergoing TEE. The different colors distinguish various cardiac structures, with the triangles indicating the position of the mitral valve. The right atrium is shown in yellow, the aorta in magenta, the left ventricle in pink, and the left atrium in purple as indicated in the cartoon in the top right. TEE: transesophageal echocardiography.
See this image and copyright information in PMC

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