Transcatheter aortic valve implantation was performed under transesophageal echocardiography (TEE) guidance in an 87-year-old man with severe aortic stenosis who was taking steroids for polymyalgia rheumatica. Preoperative computed tomography (CT) showed a lateral positional shift of the esophagus due to the enlarged left atrium (Picture 1, yellow arrows). Intraoperative TEE was mainly performed via the transgastric approach because of the difficulty in obtaining usual intraoperative guidance images (Picture 2). The total procedure time was 120 min. On returning to his room after the procedure, the patient suddenly vomited a large amount of blood. Emergency upper gastrointestinal endoscopy revealed a superficial linear mucosal injury with hemorrhage in the posterior wall of the gastric body. Bleeding was stopped by endoscopic clipping (Picture 3A, B).
Picture 1.
Picture 2.
Picture 3.
The frequency of probe manipulation in the stomach, as well as the fragility of the gastric mucosal tissue in an elderly patient on long-term steroid therapy, were considered to be the cause of intraoperative mechanical gastric mucosal injury (1).
The authors state that they have no Conflict of Interest (COI).
References
- 1.Freitas-Ferraz AB, Rodés-Cabau J, Junquera Vega L, et al. Transesophageal echocardiography complications associated with interventional cardiology procedures. Am Heart J 221: 19-28, 2020. [DOI] [PubMed] [Google Scholar]