Feasibility and complications of single-plane and biplane versus multiplane transesophageal imaging: a review of 2947 consecutive studies.

OBJECTIVE

To analyze and compare the incidence of procedural complications and failure of intubation with various sizes of probes used in transesophageal echocardiography.

DESIGN

Retrospective chart review.

SETTING

A Canadian, tertiary care hospital.

PATIENTS: A total of 2947 consecutive transesophageal echocardiographic patient examinations between January 1992 and March 1996 at the University of Ottawa Heart Institute, Ottawa, Ontario.

RESULTS

The multiplane probe (MP) was used in 1274 studies, biplane (BP) in 1642 and single plane (SP) in 31. Data for BP and SP were combined because of their similar size. Complications or failed intubation occurred in 86 studies (2.9%). There were 53 complications (1.8%) and 40 failed intubations (1.4%). Seven patients (0.3%) had both. Complications were death in one, tracheal intubation or bronchospasm in nine, bleeding in nine, angina in two, pulmonary edema in two, superficial thrombophlebitis in two, supraventricular tachycardia in one and minor adverse events in 27. Complications were unrelated to the choice of probe (MP 2%, BP and SP 1.7%, not significant). Failure of intubation (40 cases) was more common with MP than with BP and SP (2.3% versus 0.7%, P = 0.0003, OR 3.5, 95% CI 1.7 to 7.5). The main reasons for failure were cervical spondylosis in 16 patients and hypersensitive pharynx despite topical anesthesia and sedation in 13 patients. Of 21 cases of failed MP intubation, 16 (76%) were subsequently successful with BP.

CONCLUSIONS

Serious complications with transesophageal echocardiography, although infrequent, do occur. The MP carries a 3.5-fold increased risk of failed intubation. In the majority of failures, successful intubation can be achieved with a smaller probe.