Oesophagotracheal perforation after intraoperative transoesphageal echocardiography in cardiac surgery

Although transoesophageal echocardiography (TOE) can be considered a safe procedure, severe complications may occur. We report an oesophagotracheal perforation diagnosed 7 days after a complex and very long four-valve replacement procedure in a patient with a poor preoperative condition. We believe that an ischaemic lesion of the oesophagotracheal wall caused by the TOE probe was the initial event leading to this perforation. This observation raises concerns about the safety of prolonged TOE monitoring and suggests that a combination of risk factors (i.e. a small stature, a very long procedure, congestive heart failure, and a low cardiac output before and after cardiopulmonary bypass) may warrant increased precautions while performing TOE during cardiac surgery.