TRANSESOPHAGEAL ECHOCARDIOGRAPHIC EXAMINATIONS
Precautions and Complications
Before performing TEE, the operator must determine that the benefits
of TEE outweigh the risks. Except in
the presence of esophageal disease or injury, the risk is quite low. Absolute contraindications
include previous esophagectomy, severe esophageal obstruction, esophageal perforation,
and ongoing esophageal hemorrhage. Relative contraindications include esophageal
diverticula, varices, and fistulas; previous esophageal surgery; and a history of
previous gastric surgery, mediastinal irradiation, unexplained swallowing difficulties,
and other conditions that might be worsened by placement and manipulation of the
TEE probe.
In some studies, TEE has been associated with an infrequent incidence
of oral and pharyngeal injuries (0.1% to 0.3%), but in other studies the incidence
of postoperative gastrointestinal complaints did not differ significantly from that
in comparable patients who had not undergone TEE.[12]
[13]
[14]
[15]
Uncontrolled studies have reported a 0.1% to 12% incidence of transient hoarseness
after TEE. Serious pharyngeal or esophageal injury after TEE has been reported but
is rare.[16]
[17]
[18]
[19]
[20]
[21]
[22]
[23]
[24]
Two case report indicate the possibility of
TEE-associated splenic injury.[25]
[26]
Among 10,218 patients (European multicenter study) undergoing TEE (primarily outpatients),
esophageal perforation occurred in 1, who subsequently died; autopsy revealed a malignant
tumor invading the esophagus.[27]
Although bacteremia
during TEE is uncommon, endocarditis has been reported in outpatients.[28]
[29]
[30]
Endocarditis
from intraoperative TEE has not been reported, and the risk is probably near zero
because antibiotics are usually administered for prevention of surgical wound infection.
In infants, TEE has a low complication rate, but even an appropriately sized TEE
probe may obstruct the airway distal to the endotracheal tube or compress the descending
aorta.[31]
[32]
[33]
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