- Email: [email protected]
A Hazard of Transesophageal Echocardiography in a Neonate
Author’s Accepted Manuscript A Hazard Of Transesophageal Echocardiography In A Neonate Madan Mohan Maddali, Mohammed Juma Alnaabi, Pranav Subbaraya Kandachar, Francois LacourGayet www.elsevier.com/locate/buildenv
PII: DOI: Reference:
S1053-0770(16)30378-0 http://dx.doi.org/10.1053/j.jvca.2016.08.039 YJCAN3825
To appear in: Journal of Cardiothoracic and Vascular Anesthesia Cite this article as: Madan Mohan Maddali, Mohammed Juma Alnaabi, Pranav Subbaraya Kandachar and Francois Lacour-Gayet, A Hazard Of Transesophageal Echocardiography In A Neonate, Journal of Cardiothoracic and Vascular Anesthesia, http://dx.doi.org/10.1053/j.jvca.2016.08.039 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1
Correspondence A Hazard Of Transesophageal Echocardiography In A Neonate By Dr. Madan Mohan Maddali, MD Senior Consultant, Department of Cardiac Anesthesia, National Heart Center Royal Hospital, Muscat, Oman. & Dr. Mohammed Juma Alnaabi, MD Department of Cardiac Anesthesia, National Heart Center Royal Hospital, Muscat, Oman. & Dr. Pranav Subbaraya Kandachar, MCh, Department of Cardiothoracic surgery, National Heart Center Royal Hospital, Muscat, Oman. & Dr. Francois Lacour-Gayet, MD Senior Consultant Department of Cardiothoracic surgery, National Heart Center Royal Hospital, Muscat, Oman.
Work attribution: Departments of Cardiac Anesthesia and Cardiothoracic surgery, National Heart Center, Royal Hospital, Muscat, Sultanate of Oman.
Address for correspondence: Dr. Madan Mohan Maddali, Senior Consultant in Anesthesia, Royal Hospital, P.B.No: 1331, P.C: 111, Seeb, Muscat, Sultanate of Oman. Tele: 00 968 99437287 E-mail: [email protected]
2
Dear editor, Intraoperative transesophageal echocardiography has contributed to improved outcomes following congenital heart surgery. However, its applicability in small children is restricted due to mechanical problems that could occur during probe manipulation (e.g.bronchial obstruction).1 Transient electromechanical disassociation due to intraoperative transesophageal echocardiography probe manipulation in an infant with a supracardiac TAPVC has been described recently.2 We report an hazard with a transesophageal echocardiography probe in a neonate. A 7- day -old term male baby [weight: 3 Kg: height: 49cms] presented with cyanosis and severe metabolic acidosis to the neonatology wing of the author’s institution. D-transposition of great arteries with intact ventricular septum was diagnosed by transthoracic echocardiography and a balloon atrial septostomy was performed to improve the arterial oxygen saturations. On the 12th day of life, the child was taken up for an arterial switch operation. Prior to sternotomy, for intraoperative transesophageal echocardiography a micro transesophageal sector array probe [Philips S8-3t Pediatric Transesophageal Transducer] compatible with Philips iE33 Ultrasound Machine [KPI ULTRASOUND INC. CA 92887 USA] was inserted through the oropharynx under the guidance of a laryngoscope. When the probe was advanced to about mid-esophageal level and gently ante-flexed in order to assess the right and left ventricular outflow tracts, the systemic arterial pressure dropped with severe dampening of the right radial artery pressure wave form [Figure-1]. Immediate with drawl of the probe resulted in restoration of the arterial wave form and the systemic arterial pressure [videoclip-1].
3
The possible mechanism could be that the transesophageal echocardiography probe compressed the pulmonary veins producing an obstruction to pulmonary venous drainage. There was no systemic ejection as there was no return of blood to the left ventricle. This problem was probably further compounded by the bolster behind the chest wall of the baby with the sternum still being intact resulting in restriction of the intra-thoracic space This report highlights one of the possible limitations of intraoperative transesophageal echocardiography during pediatric cardiac surgery. It is important that the operator should be on the lookout for mechanical problems while performing intraoperative transesophageal echocardiography especially in small children.
References 1. Practice guidelines for perioperative transesophageal echocardiography. An updated report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. American Society of Anesthesiologists and Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Anesthesiology 112:1084-1096, 2010. 2. Maddali MM, Nishant AR, Valliattu J et al: Transient Electromechanical Dissociation Due To A Trans-esophageal Echocardiography Probe. Ann Thorac Surg. DOI: 0.1016/j.athoracsur.2016.04.078
4
Figure legends 1. Figure-1. Hemodynamic monitor showing the flattening of the invasive arterial pressure wave form with the advancement of the transesophageal echocardiography probe with the baby’s chest closed.
PII: DOI: Reference:
S1053-0770(16)30378-0 http://dx.doi.org/10.1053/j.jvca.2016.08.039 YJCAN3825
To appear in: Journal of Cardiothoracic and Vascular Anesthesia Cite this article as: Madan Mohan Maddali, Mohammed Juma Alnaabi, Pranav Subbaraya Kandachar and Francois Lacour-Gayet, A Hazard Of Transesophageal Echocardiography In A Neonate, Journal of Cardiothoracic and Vascular Anesthesia, http://dx.doi.org/10.1053/j.jvca.2016.08.039 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1
Correspondence A Hazard Of Transesophageal Echocardiography In A Neonate By Dr. Madan Mohan Maddali, MD Senior Consultant, Department of Cardiac Anesthesia, National Heart Center Royal Hospital, Muscat, Oman. & Dr. Mohammed Juma Alnaabi, MD Department of Cardiac Anesthesia, National Heart Center Royal Hospital, Muscat, Oman. & Dr. Pranav Subbaraya Kandachar, MCh, Department of Cardiothoracic surgery, National Heart Center Royal Hospital, Muscat, Oman. & Dr. Francois Lacour-Gayet, MD Senior Consultant Department of Cardiothoracic surgery, National Heart Center Royal Hospital, Muscat, Oman.
Work attribution: Departments of Cardiac Anesthesia and Cardiothoracic surgery, National Heart Center, Royal Hospital, Muscat, Sultanate of Oman.
Address for correspondence: Dr. Madan Mohan Maddali, Senior Consultant in Anesthesia, Royal Hospital, P.B.No: 1331, P.C: 111, Seeb, Muscat, Sultanate of Oman. Tele: 00 968 99437287 E-mail: [email protected]
2
Dear editor, Intraoperative transesophageal echocardiography has contributed to improved outcomes following congenital heart surgery. However, its applicability in small children is restricted due to mechanical problems that could occur during probe manipulation (e.g.bronchial obstruction).1 Transient electromechanical disassociation due to intraoperative transesophageal echocardiography probe manipulation in an infant with a supracardiac TAPVC has been described recently.2 We report an hazard with a transesophageal echocardiography probe in a neonate. A 7- day -old term male baby [weight: 3 Kg: height: 49cms] presented with cyanosis and severe metabolic acidosis to the neonatology wing of the author’s institution. D-transposition of great arteries with intact ventricular septum was diagnosed by transthoracic echocardiography and a balloon atrial septostomy was performed to improve the arterial oxygen saturations. On the 12th day of life, the child was taken up for an arterial switch operation. Prior to sternotomy, for intraoperative transesophageal echocardiography a micro transesophageal sector array probe [Philips S8-3t Pediatric Transesophageal Transducer] compatible with Philips iE33 Ultrasound Machine [KPI ULTRASOUND INC. CA 92887 USA] was inserted through the oropharynx under the guidance of a laryngoscope. When the probe was advanced to about mid-esophageal level and gently ante-flexed in order to assess the right and left ventricular outflow tracts, the systemic arterial pressure dropped with severe dampening of the right radial artery pressure wave form [Figure-1]. Immediate with drawl of the probe resulted in restoration of the arterial wave form and the systemic arterial pressure [videoclip-1].
3
The possible mechanism could be that the transesophageal echocardiography probe compressed the pulmonary veins producing an obstruction to pulmonary venous drainage. There was no systemic ejection as there was no return of blood to the left ventricle. This problem was probably further compounded by the bolster behind the chest wall of the baby with the sternum still being intact resulting in restriction of the intra-thoracic space This report highlights one of the possible limitations of intraoperative transesophageal echocardiography during pediatric cardiac surgery. It is important that the operator should be on the lookout for mechanical problems while performing intraoperative transesophageal echocardiography especially in small children.
References 1. Practice guidelines for perioperative transesophageal echocardiography. An updated report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. American Society of Anesthesiologists and Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Anesthesiology 112:1084-1096, 2010. 2. Maddali MM, Nishant AR, Valliattu J et al: Transient Electromechanical Dissociation Due To A Trans-esophageal Echocardiography Probe. Ann Thorac Surg. DOI: 0.1016/j.athoracsur.2016.04.078
4
Figure legends 1. Figure-1. Hemodynamic monitor showing the flattening of the invasive arterial pressure wave form with the advancement of the transesophageal echocardiography probe with the baby’s chest closed.