Transesophageal echocardiography-related massive gastrointestinal bleeding during cardiac surgery

Transesophageal echocardiography (TEE) has become a standard intraoperative monitor during cardiac surgery. Although generally considered safe, some cases of major TEE-related complications have been reported. We present a case of a 71-year-old man with aortic aneurysm and aortic regurgitation scheduled for total arch replacement and aortic valve replacement. During the cardiopulmonary bypass period, massive gastric bleeding occurred. Emergency esophagogastroduodenoscopy (EGD) was performed during surgery and a 2-cm deep laceration was observed at the gastroesophageal junction, suggesting Mallory-Weiss syndrome caused by TEE. Since it was impossible to control massive bleeding using EGD, Sengstaken-Blakemore tube was inserted through the stomach to compress the bleeding site. Massive gastric bleeding was controlled after reversal of the effect of heparin. Since TEE might cause complications, anesthesiologists should manipulate the TEE probe gently with caution. If massive gastric bleeding is suspected during surgery, immediate EGD should be considered for diagnosis and further management.