Fortunately, there are relatively few complications of transesophageal echocardiography (TEE). When they do occur, however, the complications can be quite serious. Untoward events include severe odynophagia, esophageal rupture, bleeding varices, bleeding ulcers, endotracheal tube dislodgement, and dental and oral trauma. The overall incidence of complications in the immediate postoperative period is ˜0.2%. In 7,200 cardiothoracic (CT) surgery patients, severe odynophagia occurred in 0.1% of all patients, and upper gastrointestinal bleed (UGIB) occurred in 0.03%. It has been reported that the incidence of UGIB is even higher. They found that 1.2% of CT surgery patients who underwent TEE had a UGIB within 30 days of the surgery, compared to 0.29% of patients who underwent CT surgery only. It is important to note that bleeding complications often go unrecognized in the immediate perioperative period.

The key, as always, is to avoid complications in the first place. TEE probes should not be placed in patients who have an absolute contraindication. These include known or recent (<6 months) esophageal trauma, active variceal bleeding, and tracheoesophageal fistula. Placement of a probe should be considered carefully if the patient has any relative contraindications, including esophageal varices, history of UGIB, esophageal strictures, and Barrett esophagus (Table 140.1). To determine whether a patient has a contraindication to TEE, you must ask the patient about history and look for signs and symptoms of these disorders. Pertinent signs and symptoms include dysphagia, odynophagia, coffee-ground emesis or hematochezia, liver disease, history of banding, significant longstanding (especially untreated) gastroesophageal reflux disease, and hiatal hernia.

TEE probes are typically placed for certain cardiac surgery procedures (especially valve replacement and repair) but may also be used to evaluate the heart during emergent intraoperative events. The ultimate decision to place a TEE probe depends on the clinical indications and the risk-benefit profile that is determined by the managing anesthesia team.