Occlusion of the right subclavian artery after insertion of a transoesophageal echocardiography probe in a neonate

Occlusion of the right subclavian artery after insertion of a transesophageal echocardiography probe in an adult with a vascular ring -A case report-

Intraoperative transesophageal echocardiography (TEE) has become an important monitoring device for patients undergoing cardiac or noncardiac surgery. Complications associated with TEE are unusual, but the potential for TEE probe compression of the posterior vascular structures has been reported in pediatric patients. We present here a case of occlusion of the right subclavian artery in an adult patient with a vascular ring after insertion of a TEE probe.

Ventilatory compromise in an infant with Tetralagy of fallot and right aortic arch after insertion of transesophageal echocardiography probe: A case report

Right aortic arch, a congenital malformation of the great vessels, can cause compression of trachea and/or esophagus. We experienced a case of ventilatory compromise in an infant with tetralogy of Fallot and right aortic arch immediately after insertion of transesophageal echocardiography probe during cardiac surgery. Although intraoperative transesophageal echocardiography can be safely performed in infants with congenital heart disease, it should be done with caution in patient with similar vascular malformation.

Down syndrome and aberrant right subclavian artery

Down syndrome (DS) may be associated with various organ system disorders. Feeding problems are frequent in children with DS and may be caused by associated defects, including congenital heart defects, gastrointestinal defects, or endocrine disorders. In the absence of these associated conditions, feeding problems are often attributed to general hypotonia. However, an aberrant right subclavian artery (ARSA), a rare vascular anomaly and an unusual cause of problems with the passage of solid food through the esophagus, has recently been suggested to occur more frequently in patients with DS. This knowledge is of importance when evaluating feeding difficulties in patients with DS. Additional investigation for identifying an ARSA may be indicated in selected patients. Diagnostic techniques, such as transthoracic echocardiography, barium contrast esophagram, angiography, or computed tomography-angiography (CT) can be used in a diagnostic flow chart. The presence of ARSA is not synonymous to the cause of feeding problems in patients with DS and corrective surgery of this vascular anomaly should be restricted to selected cases.

Transoesophageal echocardiography in monitoring, guiding, and evaluating surgical repair of congenital cardiac malformations in children

OBJECTIVE

To evaluate the role of transoesophageal echocardiography and problems related to safety during the surgical repair of congenital cardiac malformations in children.

METHODS

We examined the transoesophageal recordings made in 350 children with congenital cardiac diseases, aged from 2 months to 17 years and 9 months, with a median age of 2.7 years, tracings having been taken both before and after cardiopulmonary bypass. All patients had been scanned by transthoracic echocardiography before the operative procedures.

RESULTS

Preoperative transoesophageal echocardiography added additional findings, or changed the diagnoses made using transthoracic echocardiography, in 33 cases (9.4%), among which the findings had therapeutic significance in 23 cases (6.6%) that altered the planned surgical procedures. Residual problems or sequels were detected by postoperative transoesophageal echocardiography in 57 cases (16.3%), with 13 patients (3.7%) requiring instant intervention or return to bypass for modifications of the surgical procedures. We encountered no severe complications due to the performance of transoesophageal echocardiography. Mild complications occurred in only 2 patients (0.6%).

CONCLUSIONS

Transoesophageal echocardiography is a useful tool with which to determine the strategies for treatment in the perioperative period, and to improve the quality of surgical procedures in children with congenital cardiac diseases. Complications were few, but still deserved careful attention to detail.