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Correspondence  |   July 2007
Gastric Perforation after Transesophageal Echocardiography for Cardiac Surgery: Was There an Indication for the Transesophageal Echocardiogram?
Author Notes
  • (Accepted for publication March 22, 2007.)
    (Accepted for publication March 22, 2007.)×
Article Information
Correspondence
Correspondence   |   July 2007
Gastric Perforation after Transesophageal Echocardiography for Cardiac Surgery: Was There an Indication for the Transesophageal Echocardiogram?
Anesthesiology 7 2007, Vol.107, 179. doi:10.1097/01.anes.0000268573.06978.07
Anesthesiology 7 2007, Vol.107, 179. doi:10.1097/01.anes.0000268573.06978.07
In Reply:—
We appreciate Dr. Augoustides' remarks regarding our case report and welcome discussion on the use of transesophageal echocardiography (TEE) in cardiac surgery.1 
In producing the original manuscript, we intentionally skirted the subject of when and whether TEE is indicated, deferring opinion and instead referencing guidelines published jointly by the American College of Cardiology, American Heart Association, and American Society of Echocardiography.2  As Dr. Augoustides highlights (referencing similar guidelines previously published by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists3), in this case, the patient had category II but no category I indications for perioperative TEE.
Notwithstanding the inherent difficulties of evaluating a diagnostic tool—as have been exhaustively deliberated in the literature regarding utility of the pulmonary artery catheter—these practice guidelines supply a concise summation of expert opinion and available observational data, affording a framework for clinical practice. Regrettably, not all of the daily decisions we make as clinicians can be founded on clear-cut evidence from well-conducted, randomized controlled trials. In the context of perioperative TEE, given the current data on risks and benefits, the practice at our institution includes routine use of TEE in cardiac surgical patients lacking contraindication.
We fully agree with Dr. Augoustides' conclusion that there are no easy answers. Because of the rarity of significant complications directly attributable to TEE, we echo his assessment that a case registry could foster elucidation of risk factors beyond those already recognized.
Wayne Soong, M.D.,* Sherif Afifi, M.D., F.C.C.M., F.C.C.P. *Northwestern University, Chicago, Illinois. w-soong@northwestern.edu
References
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