Transesophageal Echocardiography (TEE) in Cardiac Surgery: Complications, Limitations, and Clinical Considerations


Authors : Dr. SK Asim Ali; Dr. Sanjeeta Umbarkar

Volume/Issue : Volume 10 - 2025, Issue 9 - September


Google Scholar : https://tinyurl.com/72cxrxay

Scribd : https://tinyurl.com/ye859sxw

DOI : https://doi.org/10.38124/ijisrt/25sep570

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Abstract : Background Transesophageal echocardiography (TEE) has become an indispensable diagnostic and monitoring tool in cardiac surgery, yet its semi-invasive nature is associated with complications and limitations. Understanding these risks is crucial for safe clinical practice.  Objective To review the potential complications, contraindications, limitations, and pitfalls of TEE in cardiac surgery and to provide a balanced appraisal of its utility in perioperative management.  Methods Literature-based review of complications, contraindications, and limitations related to TEE, supported by evidence from large case series and guideline documents. Clinical data were synthesized from key published studies and institutional experiences.  Results Major complications of TEE are rare, ranging from 0.2% to 0.5% in diagnostic settings, with mortality below 0.01%. Intraoperative use increases complication risk (0.2–1.2%), including esophageal trauma, arrhythmias, airway obstruction, and hemodynamic compromise. Pediatric patients present additional risks due to anatomical constraints. Contraindications include esophageal pathologies and recent upper GI surgery. Limitations include restricted visualization of certain cardiac structures and artifacts that may mimic pathology.  Conclusion Despite its risks, TEE remains an essential perioperative tool in cardiac surgery. Awareness of its complications and limitations allows clinicians to optimize patient safety while benefiting from its diagnostic power.

Keywords : Transesophageal Echocardiography, Cardiac Surgery, Complications, Limitations, Perioperative Monitoring.

References :

  1. Hilberath JN, Oakes DA, Shernan SK, et al. Safety of transesophageal echocardiography. J Am Soc Echocardiogr. 2010; 23:1115-27.
  2. Kallmeyer IJ, Collard CD, Fox JA, et al. The safety of intraoperative transesophageal echocardiography: a case series of 7200 cardiac surgical patients. Anesth Analg. 2001; 92:1126-30.
  3. Min JK, Spencer KT, Furlong KT, et al. Clinical features of complications from transesophageal echocardiography: a single-center case series of 10,000 consecutive examinations. J Am Soc Echocardiogr. 2005; 18:925-9.
  4. Muralidhar K, Kapoor PM, et al. Perioperative transesophageal echocardiography guidelines. Ann Card Anaesth. 2013; 16:321-9.
  5. Flachskampf FA, Daniel WG. Transesophageal echocardiography: state of the art. Ann Intern Med. 1991; 115:425-33.
  6. American Society of Anesthesiologists, Society of Cardiovascular Anesthesiologists. Practice guidelines for perioperative transesophageal echocardiography. Anesthesiology. 2010; 112:1084-96.

 

 

  1. Swaminathan M, Nicoara A, Phillips-Bute B, et al. Utility of intraoperative transesophageal echocardiography in valve surgery. J Thorac Cardiovasc Surg. 2013; 145:1030-7.
  2. Shanewise JS, Cheung AT, Aronson S, et al. ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination. Anesth Analg. 1999; 89:870-84.
  3. Sidebotham D, Allen SJ, McGeorge AD, et al. Safety and feasibility of transesophageal echocardiography in the intensive care unit: a prospective study of 2000 examinations. Intensive Care Med. 1998; 24:683-9.

10. Fleming RM, Boyd D, Forster J, et al. Complications of TEE in anticoagulated patients. Echocardiography. 2001; 18:539-42

Background Transesophageal echocardiography (TEE) has become an indispensable diagnostic and monitoring tool in cardiac surgery, yet its semi-invasive nature is associated with complications and limitations. Understanding these risks is crucial for safe clinical practice.  Objective To review the potential complications, contraindications, limitations, and pitfalls of TEE in cardiac surgery and to provide a balanced appraisal of its utility in perioperative management.  Methods Literature-based review of complications, contraindications, and limitations related to TEE, supported by evidence from large case series and guideline documents. Clinical data were synthesized from key published studies and institutional experiences.  Results Major complications of TEE are rare, ranging from 0.2% to 0.5% in diagnostic settings, with mortality below 0.01%. Intraoperative use increases complication risk (0.2–1.2%), including esophageal trauma, arrhythmias, airway obstruction, and hemodynamic compromise. Pediatric patients present additional risks due to anatomical constraints. Contraindications include esophageal pathologies and recent upper GI surgery. Limitations include restricted visualization of certain cardiac structures and artifacts that may mimic pathology.  Conclusion Despite its risks, TEE remains an essential perioperative tool in cardiac surgery. Awareness of its complications and limitations allows clinicians to optimize patient safety while benefiting from its diagnostic power.

Keywords : Transesophageal Echocardiography, Cardiac Surgery, Complications, Limitations, Perioperative Monitoring.

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Paper Submission Last Date
31 - December - 2025

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