Non-invasive ventilation-aided transoesophageal echocardiography in high-risk patients: a pilot study

Aims Transoesophageal echocardiography (TEE) may require patient sedation, eventually leading to respiratory depression,
a risky condition in severe cardiac disease. Non-invasive ventilation (NIV) has been applied during diagnostic
manoeuvres, but its use during TEE has not been reported. We describe NIV-aided continuous TEE monitoring
under sedation in the supine position in three consecutive orthopnoeic patients with severe aortic valve stenosis:
two of them underwent percutaneous aortic valve implantation, and one underwent aortic valvuloplasty.
Methods
and results
The TEE probe was passed through a hole performed with a surgical cutter in an NIV face-mask. Pulsoximetry, heart
rate, arterial blood pressure, respiratory rate, arterial blood gases, patients’ comfort, and patient’s sedation were
monitored throughout the procedure. Percutaneous aortic valve implantation procedures lasted almost 2 h, while
the valvuloplasty procedure lasted 70 min. Non-invasive ventilation and continuous TEE were performed throughout
the procedures without technical problems or respiratory or haemodynamic complications, and all patients felt
always comfortable.
Conclusion Non-invasive ventilation through a modified face-mask allowed to perform continuous TEE examination and to avoid
tracheal intubation and general anaesthesia in three high-risk patients undergoing beating heart treatment of aortic
valve stenosis.