The Safety of Emergency Transesophageal Echocardiography in the Dlagnosis of Thoracic Aortic Diseases

ABSTRACT

BACKGROUND: Early recognition of thoracic aortic disease is critical to reduce morbidity and mortality. Transesophageal echocardiography(TEE) has recently proved superior to traditional diagnostic modalities such as computed tomogram(CT) scan, aortography and magnetic resonance imaging(MRI) in assessing thoracic aortic diseases because of high sensivity and portability. However, the safety of emergency TEE has never been evaluated in patients with acute aortic disease in the emergency department. The purpose of this study was to evaluate the safety of TEE as an emergency diagnostic procedure to detect thoracic aortic diseases. METHOD: From May 1994 to July 1996,25 patients who were suspicious of thoracic aortic disease and underwent TEE as the first diagnostic tool in the emergency department were enrolled. Biplane TEE was used under the administration of low-dose benzodiazepine and phayngeal spray of lidocaine. Airway protection by endotracheal intubation was done if the patient had no gag reflex or unconsciousness. RESULT: Among the 25 patients including 16 patients with nontraumatic cause and 9 patients with trauma, 18 patients had thoracic aortic diseases on TEE. Three of 9 patients with trauma had aortic injury(an aortic tear, an aortic aneurysm, an aortic subintimal hematoma). Fifteen of 16 patients with nontraumatic cause revealed aortic dissection on TEE. Systolic blood pressure and heart rate were not significantly changed by TEE. There was no complication during TEE in 23 patients(92%). Severe hypertension was noted in a patient and cardiac tamponade from previous pericardial effusion was developed in a patient during TEE. CONCLUSION: Our observation suggests that TEE is a safe diagnostic modality to detect thoracic aortic diseases in the emergency department.