Difficult insertion of a transesophageal echocardiography probe for cardiac surgery not only before but also immediately after thyroid goiter resection in a patient with chronic esophageal compression by the goiter: a case report.

Abstract

Background: Transesophageal echocardiography (TEE) is an essential tool during minimally invasive cardiac surgery (MICS), although inserting a TEE probe is sometimes challenging. We experienced difficult placement of an adult TEE probe for cardiac surgery due to chronic compression of the esophagus by thyroid goiter. The aim of this case report is to highlight the challenges of TEE probe insertion due to chronic esophageal compression caused by a thyroid goiter and to discuss considerations for simultaneous thyroid tumor resection and mitral valvuloplasty (MVP).

Case description: A 78-year-old man (170 cm, 68 kg) with severe mitral regurgitation (MR) was scheduled for simultaneous thyroid surgery and MVP, since preoperatively, experienced cardiologists had failed to place an adult TEE probe for preoperative TEE examinations, and they had had to use a pediatric TEE probe with poor image quality. First, otolaryngologists completely resected the left thyroid lobe including goiter. However, even after tumor resection, experienced anesthesiologists could not advance the adult TEE probe beyond the pharynx due to strong resistance, even using video laryngoscopy to visualize the esophageal inlet. Again, they had to use a pediatric probe for intraoperative evaluation.

Conclusions: Such previously unreported experiences suggested that esophageal stenosis due to chronic compression by goiter would not improve completely at least immediately after tumor resection. When usual TEE probe placement is difficult, alternative methods for assessing the mitral valve (MV) should be considered.