開心術時の経食道心エコーで食道穿孔をきたした1例

Esophageal Perforation on Transesophageal Echocardiography in Open-heart Surgery：Report of a Case

はじめに　心臓血管外科領域の手術において経食道心エコー（TEE）はほぼ必須であり，TEE挿入による合併症の頻度は0.18％（口腔・咽頭損傷0.1～0.3％，食道穿孔0.01～0.03％），死亡率0.0098％とされ，ほかの心血管系モニターに対して安全と考えられている1，2）．しかし全身麻酔下では患者の協力が得られず，また気管チューブや上気道の筋緊張低下によりTEE挿入に難渋することもしばしばみられる．

A 70-year-old woman, who was taking prednisolone to treat Takayasu arteritis, underwent surgery for aortic regurgitation and aneurysm of the ascending aorta. The probe of the transesophageal echocardiography （TEE） could not be inserted due to resistance during anesthesia induction and was inserted after starting cardiopulmonary bypass. The right pneumothorax was observed during surgery. After surgery, fever and a high C-reactive protein level continued, and a computed tomography （CT） examination revealed right thoracic empyema together with free air around the esophagus. The esophageal perforation diagnosis was confirmed by upper endoscopy. Esophageal leakage continued despite emergency esophageal repair and enterostomy. Although esophagectomy was performed 2 months later, the patient died 6 months after cardiac surgery due to sepsis. Thus, esophageal perforation related to TEE in open-heart surgery was considered to be associated with a poor prognosis.