New injuries are common when transesophageal echocardiography (TEE) is used to guide a structural heart intervention, according to new research published in the Journal of the American College of Cardiology. What can specialists do to limit such complications?
The study’s authors tracked 50 patients undergoing interventions such as mitral and tricuspid valve repair and left atrial appendage closure. An esophagogastroduodenoscopy (EGD) was performed on each patient before and after the procedure to check for any signs of a new injury. All patients were treated from November 2018 to November 2019 at a single institution.
Overall, 86% of patients had a new injury after the TEE-guided intervention. For 40% of patients, the injury was a complex lesion. Longer procedures and “poor or suboptimal image quality” were both independently associated with a greater risk of a complex lesion.
“Despite the relative safety of TEE, injuries related to this type of imaging occur in the vast majority of patients undergoing structural cardiac interventions,” wrote Afonso B. Freitas-Ferraz, MD, department of cardiology at Laval University in Quebec, Canada, and colleagues.
Freitas-Ferraz et al. listed numerous ways healthcare providers can work to limit these injuries. During the planning phase, for instance, the care team should determine if TEE and/or general anesthesia are truly necessary.
“Alternative strategies to consider include doing the procedure under conscious sedation and adopting alternative imaging tools such as intracardiac echocardiography or using pediatric probes, which are less traumatic but have the downside of not supporting three-dimensionality and having an inferior image quality compared with the standard adult probe,” the authors wrote.
Also, more attention should be paid to whether or not a patient has known issues with swallowing. And when the patient has known esophageal disease, “the potential benefits of performing a TEE should be balanced against the risks.” If there is any doubt, the authors added, an upper gastrointestinal specialist should be asked to sign off on the care strategy.
Imaging specialists actually operating the TEE-guided intervention must also be sure to “minimize unnecessary manipulation” and “consider the need to terminate a procedure with a low expected success rate based on a long TEE imaging time.”
The full study is available here.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.