Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
J Am Coll Cardiol. 2020 Jun 30;75(25):3164-3173. doi: 10.1016/j.jacc.2020.04.069.
Despite the widespread use of transesophageal echocardiography (TEE) to guide structural cardiac interventions, studies evaluating safety in this context are lacking.
This study sought to determine the incidence, types of complications, and factors associated with esophageal or gastric lesions following TEE manipulation during structural cardiac interventions.
This was a prospective study including 50 patients undergoing structural cardiac interventions in which TEE played a central role in guiding the procedure (mitral and tricuspid valve repair, left atrial appendage closure, and paravalvular leak closure). An esophagogastroduodenoscopy (EGD) was performed before and immediately after the procedure to look for new injuries that might have arisen during the course of the intervention. Patients were divided in 2 cohorts according to the type of injury: complex lesions (intramural hematoma, mucosal laceration) and minor lesions (petechiae, ecchymosis). The factors associated with an increased risk of complications were assessed.
Post-procedural EGD showed a new injury in 86% (n = 43 of 50) of patients, with complex lesions accounting for 40% (n = 20 of 50) of cases. Patients with complex lesions presented more frequently with an abnormal baseline EGD (70% vs. 37%; p = 0.04) and had a higher incidence of post-procedural dysphagia or odynophagia (40% vs. 10%; p = 0.02). Independent factors associated with an increased risk of complex lesions were a longer procedural time under TEE manipulation (for each 10-min increment in imaging time, odds ratio: 1.27; 95% confidence interval: 1.01 to 1.59) and poor or suboptimal image quality (odds ratio: 4.93; 95% confidence interval: 1.10 to 22.02).
Most patients undergoing structural cardiac interventions showed some form of injury associated with TEE, with longer procedural time and poor or suboptimal image quality determining an increased risk. Imaging experts performing this technique should be aware of the nature of potential complications, to take the necessary precautions to prevent their occurrence and facilitate early diagnosis and treatment.
尽管经食管超声心动图（TEE）广泛用于指导结构性心脏介入，但在此背景下评估安全性的研究仍较少。
本研究旨在确定 TEE 操作期间发生结构性心脏介入时食管或胃损伤的发生率、类型以及与损伤相关的因素。
这是一项前瞻性研究，纳入 50 例行结构性心脏介入的患者，其中 TEE 在指导手术中发挥了核心作用（二尖瓣和三尖瓣修复、左心耳封堵和瓣周漏封堵）。在操作前后进行食管胃十二指肠镜检查（EGD）以寻找可能在介入过程中发生的新损伤。根据损伤类型，患者被分为 2 组：复杂损伤（壁内血肿、黏膜撕裂）和轻微损伤（瘀点、瘀斑）。评估了与并发症风险增加相关的因素。
术后 EGD 显示 50 例患者中有 86%（n=43）出现新损伤，其中复杂损伤占 40%（n=20）。复杂损伤患者更常出现基线 EGD 异常（70% vs. 37%；p=0.04），且术后吞咽困难或咽喉痛发生率更高（40% vs. 10%；p=0.02）。与复杂损伤风险增加相关的独立因素包括 TEE 操作下的手术时间较长（每增加 10 分钟的成像时间，比值比：1.27；95%置信区间：1.01 至 1.59）和图像质量差或欠佳（比值比：4.93；95%置信区间：1.10 至 22.02）。
大多数行结构性心脏介入的患者均存在与 TEE 相关的某种形式的损伤，手术时间较长和图像质量差或欠佳决定了风险增加。进行该技术的影像专家应了解潜在并发症的性质，采取必要的预防措施以防止其发生，并促进早期诊断和治疗。
