Background Although transesophageal echocardiography (TEE) is considered a relatively safe diagnostic monitoring method, blind probe insertion is associated with pharyngeal trauma. Through visual observation of the esophageal inlet with the McGRATH video laryngoscope, it may be possible to insert the TEE probe at an appropriate angle and prevent pharyngeal trauma. We conducted a manikin study to investigate whether the use of the McGRATH video laryngoscope for TEE probe insertion reduced the pressure on the posterior pharyngeal wall. Methods Twenty-seven junior (inexperienced group) and 10 senior (experienced group) anesthesiologists participated in this study. The TEE probe was inserted into an airway manikin in a blind fashion (blind group) or under visualization with the McGRATH (McGRATH group) video laryngoscope (three times each). A sealed bag filled with normal saline was placed on the back of the posterior pharyngeal wall of the manikin and connected to a patient monitoring system via a pressure transducer. We measured the internal bag pressure and approximated this value to the pressure on the posterior pharyngeal wall. Results The pressure on the posterior pharyngeal wall was significantly lower in the McGRATH group than in the blind group (p < 0.001) and was significantly reduced when the McGRATH was employed in both the inexperienced (p < 0.001) and experienced (p < 0.001) groups. Conclusions These findings suggest that TEE probe insertion under the assistance of the McGRATH video laryngoscope can reduce the pressure on the posterior pharyngeal wall, regardless of the clinician’s experience, and may inform clinical practice with the potential to reduce probe insertion-associated complication rates.

Background The left ventricular (LV) vent is commonly inserted via the right superior pulmonary vein (RSPV) and directed toward the LV cavity through the mitral valve. We report a rare case in which the tip of the LV vent was misplaced into the aortic root across the aortic valve. Case presentation An 88-year-old man was scheduled to undergo the Bentall procedure. After initiation of cardiopulmonary bypass, the LV vent was inserted via the RSPV. Anterograde cardioplegia was administered via the aortic root cannula after the ascending aorta was cross-clamped. The electrocardiogram did not result in complete cardiac arrest, even after delivery of two-thirds of the planned dose. A transesophageal echocardiographic examination showed that the tip of the LV vent was misplaced into the aortic root across the aortic valve. Conclusions It is important to confirm the tip position by transesophageal echocardiography to prevent severe complications associated with the LV vent.

No abstract

No abstract