ABSTRACT
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is a minimally invasive surgery. However, there is a risk of surgical manipulation causing detachment of a lesion of the aortic valve, which can result in various embolisms. CASE PRESENTATION: An 87-year-old woman with symptomatic severe aortic valve stenosis was scheduled for transfemoral TAVI under monitored anesthesia. Preoperative examination revealed severe calcification of the aortic valve, but there was no calcification in the ascending aorta. After a delivery catheter system passed the aortic valve, left radial arterial pressure dropped significantly, and complete atrioventricular block (CAVB) occurred. Catecholamine administration and ventricular pacing improved hemodynamics, and a self-expandable valve was implanted. CAVB resolved after surgery, but her state of consciousness was poor, and her left hand became ischemic. Imaging studies revealed multiple embolic infarcts in her bilateral cerebrum and cerebellum. CONCLUSIONS: It should be noted that there is a risk of detachment of a calcified lesion of the aortic valve during TAVI, which can cause embolisms not only in the brain but also in the extremities and coronary arteries.
ABSTRACT
BACKGROUND: Although transesophageal echocardiography (TEE) is considered a relatively safe diagnostic monitoring method, blind probe insertion is associated with pharyngeal trauma. Through visual observation of the esophageal inlet with the McGRATH video laryngoscope, it may be possible to insert the TEE probe at an appropriate angle and prevent pharyngeal trauma. We conducted a manikin study to investigate whether the use of the McGRATH video laryngoscope for TEE probe insertion reduced the pressure on the posterior pharyngeal wall. METHODS: Twenty-seven junior (inexperienced group) and 10 senior (experienced group) anesthesiologists participated in this study. The TEE probe was inserted into an airway manikin in a blind fashion (blind group) or under visualization with the McGRATH (McGRATH group) video laryngoscope (three times each). A sealed bag filled with normal saline was placed on the back of the posterior pharyngeal wall of the manikin and connected to a patient monitoring system via a pressure transducer. We measured the internal bag pressure and approximated this value to the pressure on the posterior pharyngeal wall. RESULTS: The pressure on the posterior pharyngeal wall was significantly lower in the McGRATH group than in the blind group (p < 0.001) and was significantly reduced when the McGRATH was employed in both the inexperienced (p < 0.001) and experienced (p < 0.001) groups. CONCLUSIONS: These findings suggest that TEE probe insertion under the assistance of the McGRATH video laryngoscope can reduce the pressure on the posterior pharyngeal wall, regardless of the clinician's experience, and may inform clinical practice with the potential to reduce probe insertion-associated complication rates.
