The use of transesophageal echocardiography (TEE) for guiding structural heart disease interventions was associated with some degree of esophageal or gastric injury in the vast majority of patients, according to a study published in the Journal of the American College of Cardiology.

Afonso B. Freitas-Ferraz, MD, et al., sought to determine the incidence, types of complications and factors associated with esophageal or gastric lesions following TEE manipulation during structural cardiac interventions due to the widespread use of TEE and lack of studies evaluating safety in this context.

The study examined 50 patients undergoing cardiac structural interventions in which TEE played a central role in guiding the procedure. Patients included in the study underwent edge-to-edge mitral valve repair (n=20), tricuspid valve repair (n=2), left atrial appendage closure (n=24) and paravalvular leak closure (n=4). An esophagogastroduodenoscopy (EGD) was performed before and immediately after the procedure that might have arisen during the intervention.

Results showed a new injury in 86% (n=43) of patients, with complex lesions accounting for 40% (n=20) of cases. Patients with complex lesions presented more frequently with an abnormal baseline EGD and had a higher incidence of post-procedural dysphagia or odynophagia. Longer procedural time under TEE manipulation and poor or suboptimal image quality were independent factors associated with an increased risk of complex lesions.

"These results highlight the clinical relevance of being aware of predisposing factors and the nature of potential TEE complications during structural cardiac interventions, in order to improve their prevention, prompt diagnosis, and optimize management strategies," write the authors of the study.

"[This] study marks an important advance in our understanding of the complications related to TEE during structural heart interventions," write Jayashri R. Aragam, MD, and Zaid I. Almarzooq, MBBCH, in an accompanying editorial comment. "Also, it highlights the importance of evaluating patients' pre-procedure risk profile before deciding on an optimal imaging strategy during transcatheter interventions and adhering to guideline-directed steps to minimize the occurrence of TEE-related gastroesophageal injuries."

Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Interventions and Imaging, Echocardiography/Ultrasound

Keywords: Echocardiography, Transesophageal, Mitral Valve, Tricuspid Valve, Deglutition Disorders, Incidence, Atrial Appendage, Cardiac Surgical Procedures, Heart Diseases, Endoscopy, Digestive System, Cardiology, Heart Valve Prosthesis Implantation, Causality

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