A & A case reports
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The reported adverse effects of perioperative transesophageal echocardiography (TEE) are mostly associated with the insertion and manipulation of the TEE probe. Recent data suggest that blind probe insertion may be associated with greater morbidity than reported previously. ⋯ Herein, we present a novel insertion technique using a soft-tipped esophageal bougie as a guide for blind TEE probe insertion in a patient undergoing cardiac surgery. The potential advantages and related safety issues are discussed.
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Acute disruption of venous return during cardiopulmonary bypass (CPB) may be due to malposition of the venous cannula, kinks or obstruction of the venous tubing by a smaller cannula, airlock, or mechanical disruption of blood flow. We describe an acute obstruction of the venous cannula by blood clots that were visualized on the transesophageal echocardiogram during CPB. Appropriate measures were taken by the surgeon to evacuate the clot and restore CPB. The clots were not seen on the transesophageal echocardiogram before CPB raising suspicion that they originated in a lower extremity and migrated to the right atrium resulting in venous cannula obstruction.