Transesophageal Echocardiography-Related Complications During Mitral Valve Repair in Dogs

Background

Transesophageal echocardiography (TEE) is an indispensable modality in cardiac surgery; however, the complications associated with its use in veterinary clinical settings remain unclear.

Hypothesis/Objectives

To investigate the complications associated with TEE probe manipulation during mitral valve repair in dogs and identify the risk factors for new mucosal injuries.

Animals

This prospective study evaluated 60 client-owned dogs that underwent TEE to support mitral valve repair.

Methods

Esophageal endoscopy was performed twice—once after anesthesia induction and once before extubation—to assess esophageal mucosal injuries during the procedure. The type of injury was classified as ‘complex’ (intramural hematoma and mucosal laceration), ‘minor’ (petechiae and ecchymosis), or ‘minute’ (visible only on narrowband imaging) lesions. During the surgery, TEE was performed three times. Hemodynamics were evaluated before the initial TEE insertion and immediately after it was removed.

Results

Of the 60 dogs, newly detected mucosal lesions were observed in 20 dogs and classified as ‘minor’ in four and ‘minute’ in 16 dogs. These ‘minute’ lesions were not visible with conventional endoscopy, and no ‘complex’ lesions were identified. No significant factors were associated with the presence of mucosal lesions. After TEE insertion, systolic blood pressure decreased from 95 ± 13 mmHg to 92 ± 11 mmHg (p = 0.008), and heart rate decreased from 128 ± 25 bpm to 123 ± 24 bpm (p < 0.001).

Conclusions and Clinical Importance

Intraoperative TEE results in a low incidence of esophageal mucosal injuries. Hemodynamic changes could occur during TEE manipulation, underscoring the need for close monitoring.