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Incidence of complications in pediatric transesophageal echocardiography: experience in 1650 cases
1Children's Hospital and Regional Medical Center, Seattle, Washington 98105, USA.
Insights
Pediatric transesophageal echocardiography is a safe procedure with a low complication rate of 3.2%. Most complications, like airway issues, occurred in smaller children during this cardiac imaging technique.
Area of Science:
- Cardiology
- Pediatric Imaging
Background:
- Pediatric transesophageal echocardiography (TEE) is crucial for diagnosing congenital heart disease.
- Assessing the safety and complication profile of TEE in pediatric populations is essential.
Purpose of the Study:
- To prospectively record and analyze the incidence, type, and severity of complications during pediatric TEE.
- To identify factors associated with complications in pediatric TEE.
Main Methods:
- Prospective data collection on 1650 pediatric patients undergoing TEE.
- Detailed recording of all encountered complications, including probe insertion failures and airway events.
- Analysis of complication rates based on patient demographics and procedure type (intraoperative vs. non-operative).
Main Results:
- An overall complication rate of 3.2% (52/1650) was observed.
- Most frequent complications included airway obstruction (1%), probe insertion failure (0.8%), and vascular compression (0.6%).
- Complications were significantly more common in smaller pediatric patients.
Conclusions:
- Pediatric transesophageal echocardiography demonstrates a low incidence of complications.
- The procedure is generally safe, with no reported deaths, significant bleeding, arrhythmias, or esophageal injuries.
- Careful attention to patient size is warranted to mitigate risks, particularly airway complications.
Abstract:
The purpose of this study was to tabulate the complications encountered in 1650 patients who underwent pediatric transesophageal echocardiography. The occurrence of complications and their type and severity were prospectively recorded. The patients had a mean age of 3.6 years (range 1 day to 21 years) and a mean weight of 17.2 kg (range 1.6 to 118 kg). Of the 1650 cases, 1534 were intraoperative. Most patients studied (97%) had congenital heart disease. Complications occurred in 52 (3.2%) of the 1650 patients. Failure to insert the probe occurred in 13 (0.8%) patients; if those cases are not counted as complications, the incidence of overall complications falls to 2.4%. Airway obstruction occurred in 14 (1%) patients, right mainstem advancement of the endotracheal tube in 3 (0.2%), inadvertent tracheal extubation in 8 (0.5%), vascular compression in 10 (0.6%), and single additional complications in 4 (0.2%). No significant bleeding, arrhythmias, esophageal injuries, or deaths occurred. Failure to insert the probe and airway complications occurred predominantly and significantly in smaller subjects. It is concluded that the incidence of complications during pediatric transesophageal echocardiography is low.
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