松村 誠, 許 俊鋭, 尾本 良三, 安達 秀雄, 高本 真一, 横手 祐二

Makoto MATSUMURA, Shunei KYO, Ryozo OMOTO, Hideo ADACHI, Shinichi TAKAMOTO, Yuji YOKOTE

埼玉医大第一外科

The First Department of Surgery, Saitama Medical School

キーワード : Transesophageal echo, Hemodynamic response, Complication

To investigate the safety of transesophageal echocardiography (TEE), we analyzed the medication and position at the time of examination and period of introduction in 648 awake patients with major cardiovascular disease. Four-hundred and seven patients (62.8%) had aortic aneurysm or mitral valve disease, and 54 patients (8.3%) suffered acute aortic dissection or severe cardiac failure. No patient had a major complication. However, TEE examination had to be interrupted due to minor complications such as angina pectoris, hypoxia, hypertension, chest pain, back pain, tachycardia, pharyngeal bleeding, vomiting, and intolerance in 9 patients (1.38%). Blood pressure and heart rate increased 23±2 mmHg (21±1%), 18±1 bpm (21±1%) respectively after introduction of the TEE probe. Medication was given in 112 cases. Intravenous injection of tranquilizing agents could reduce the risk of complications in patients with acute aortic dissection and severe cardiac failure. Use of an anticholinergic agent incresed heart rate, and tachycardia (HR> 100 bpm) was found in 71% of 84 patients. Fifty-four of 648 patients had to be lain on the left side because of the acute phase of aortic dissection or severe heart failure: however no significant difference could be found in occurrence of complications between the supine and left decubitus positions. A higier incidence of complications was continued more than 30 minute. In conclusion, TEE examination can be safely performed in all patients without much complication; however, appropriate choice of medication and position prior to introduction and attention to the inserting period and hemodynamic changes during examination are important to ensure comfort and sefety.