Transesophageal echocardiography: Increased risk by repeated attempts to insert the transducer in patients with coronary artery disease?

Abstract

The question of whether several attempts at transducer insertion increase the risk of performing transesophageal echocardiography (TEE) in patients with coronary artery disease (CAD) has not been addressed to date. In the course of performing TEE in 45 patients with CAD, two or more attempts to insert the transducer were necessary in 9 cases. During various attempts, heart rate, blood pressure and ST‐segment depression were recorded and correlated with the findings of the exercise electrocardiogram (ECG) and coronary angiography. Insertion was successful in six patients after two attempts and in three other patients after three, four, and five attempts, respectively. Heart rate rose significantly (p<0.005) with the increase of insertion attempts. In one patient, it continued to rise at the fourth attempt, reaching 216% compared with the initial heart rate. Systolic blood pressure rose by 5%, whereas there was hardly any change in diastolic blood pressure. As the number of insertion attempts increased, we recorded a continuous ST‐segment depression in eight patients with angiographic changes of the coronary artery system. The depression was already significant at the first attempt (p<0.05). Compared with the initial reading (0.053 mV), the increase was 335% (p<0.01) after the second attempt (0.231 mV). One patient whose angiographic findings were normal had no ST‐segment depression during TEE. In all eight patients with CAD ST‐segment depression during TEE was > 0.2 mV. Since none of the patients complained of angina pectoris, the ST‐segment depressions satisfied all the criteria of silent myocardial ischemia. Thus, in the performance of TEE in patients with CAD, ST‐segment depression is consistently intensified with each additional attempt to insert the transducer and must be taken as an indicator of myocardial ischemia. Investigators should consider systemic analgesia (conscious sedation) when performing TEE in patients with CAD. Copyright © 1993 Wiley Periodicals, Inc.