Swallowing Dysfunction and TEE

Authors Full NameKohr, Lisa M. Dargan, Margaret. Hague, Amy. Nelson, Suzanne P. Duffy, Elise. Backer, Carl L. Mavroudis, Constantine.
InstitutionDivision of Cardiovascular-Thoracic Surgery, Department of Speech and Language Pathology, Children's Memoiral Hospital,
TitleThe incidence of dysphagia in pediatric patients after open heart procedures with transesophageal echocardiography.
SourceAnnals of Thoracic Surgery. 76(5):1450-6, 2003 Nov.

AbstractBACKGROUND: Pediatric patients who undergo open heart operations may be at risk for the development of dysphagia because of interventions such as intubation and transesophageal echocardiography. Although the occurrence of dysphagia after cardiac surgical procedures in adults is reported to be 3% to 4%, the incidence in children and adolescents has not been documented. This study was undertaken to determine the incidence of and risk factors contributing to dysphagia in pediatric patients after open heart procedures. METHODS: Fifty patients were evaluated after open heart operations with transesophageal echocardiography between March 1, 1999, and September 30, 1999. The diagnosis of dysphagia was made by a speech pathologist using a clinical swallowing evaluation. Potential predictors examined included demographic variables, anatomical diagnosis, surgical procedure, size of the transesophageal echocardiographic probe in relation to body size, length of probe insertion time, preoperative patient acuity status, duration of intubation, and time until discharge. RESULTS: Dysphagia was found in 9 (18%) of the 50 patients. Risk factors identified were age of less than 3 years (odds ratio, 20.4; 95% confidence interval, 2.7 to 157; p = 0.002), intubation prior to operation (odds ratio, 17.7; 95% confidence interval, 9.4 to 210; p = 0.004), intubation for more than 7 days (odds ratio, 74.7; 95% confidence interval, 13.8 to 405; p = 0.001), and operation for left-sided obstructive lesions (odds ratio, 1.9; 95% confidence interval, 2.2 to 8.3; p = 0.038). The size of the transesophageal echocardiographic probe in relation to the weight of the patient was found to be predictive (p = 0.0001) of dysphagia. Vocal cord paralysis was noted in 4 (8%) of the 50 patients postoperatively. Adverse events related to aspiration occurred in 2 patients (4%). At discharge, nasogastric tube feedings were required in 6 patients (12%), and thickened feedings were recommended for 3 (6%) of the 50 patients. Resolution of dysphagia ranged from 13 to 150 days. CONCLUSIONS: Eighteen percent of patients had dysphagia after an open heart operation with transesophageal echocardiography. Age of less than 3 years, preoperative patient acuity status, longer intubation times, and operation for left-sided obstructions are risk factors for dysphagia in this cohort of pediatric patients. The size of the transesophageal echocardiography probe in relation to the patient's weight was predictive of dysphagia. Physicians should consider using the new mini-multiplane transesophageal echocardiographic probes in patients weighing less than 5.5 kg. Vigilance in monitoring for the signs of preoperative and postoperative dysphagia with prompt referral to a speech therapist can substantially reduce patient morbidity, length of hospital stay, and requirement of prolonged nasogastric tube use.

AuthorsRousou JA. Tighe DA. Garb JL. Krasner H. Engelman RM. Flack JE 3rd. Deaton DW.
Authors Full NameRousou, J A. Tighe, D A. Garb, J L. Krasner, H. Engelman, R M. Flack, J E 3rd. Deaton, D W.
InstitutionDepartment of Anesthesiology, Baystate Medical Center, Springfield, Massachusetts 01107, USA.
TitleRisk of dysphagia after transesophageal echocardiography during cardiac operations.
SourceAnnals of Thoracic Surgery. 69(2):486-9; discussion 489-90, 2000 Feb.
Local MessagesMUSC Library has journal title; click Library Holdings link for issues.
AbstractBACKGROUND: Dysphagia can be a significant complication following cardiac operations. This study evaluates its incidence and relationship to intraoperative transesophageal echocardiography (TEE) for specific indications versus known factors such as stroke or prolonged intubation. METHODS: Records of 838 consecutive cardiac surgical patients were reviewed, and categorized into those who received TEE for specific indications versus those who did not (nonTEE). Dysphagia was recorded when symptoms were confirmed by barium cineradiography. Multiple logistic regression identified significant factors causing dysphagia. RESULTS: TEE was significantly related to the development of postoperative dysphagia by multiple logistic regression (p <> CONCLUSIONS: TEE may be an independent risk factor for dysphagia following cardiac operations.

AuthorsHogue CW Jr. Lappas GD. Creswell LL. Ferguson TB Jr. Sample M. Pugh D. Balfe D. Cox JL. Lappas DG.
Authors Full NameHogue, C W Jr. Lappas, G D. Creswell, L L. Ferguson, T B Jr. Sample, M. Pugh, D. Balfe, D. Cox, J L. Lappas, D G.
InstitutionDepartment of Radiology, Washington University School of Medicine, St. Louis, Mo., USA.
TitleSwallowing dysfunction after cardiac operations. Associated adverse outcomes and risk factors including intraoperative transesophageal echocardiography.
SourceJournal of Thoracic & Cardiovascular Surgery. 110(2):517-22, 1995 Aug.
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AbstractThe frequency, importance to patient outcomes, and independent predictors of postoperative swallowing dysfunction documented by barium cineradiography were examined in 869 patients undergoing cardiac operations over a 12-month period. Swallowing dysfunction was diagnosed in 34 patients (4% incidence) and was associated with documented pulmonary aspiration in 90% of these patients, increased frequency of pneumonia (p < p =" 0.0002)," p =" 0.0001)," p =" 0.0001)." p =" 0.001)," class="bibrecord-highlight">transesophageal echocardiography (p = 0.003). Dysfunctional swallowing after cardiac operations, a serious complication significantly related to postoperative respiratory morbidity and extended length of hospitalization, is more common in older patients. An association between intraoperative use of transesophageal echocardiography and swallowing dysfunction was also observed in our patients.