Written By: Adam Choose, Affected person Advocate, Writer & Web site FounderMedical Skilled: Marc Gerdisch, MD, Chief of Cardiac Surgical procedure, Franciscan HealthPublished: August 9, 2024
I simply obtained a really attention-grabbing query from Lori about coronary heart valve surgical procedure and corkscrew esophagus, often known as tortuous esophagus.
In her e mail, Lori requested me, “Hello Adam, I’ve been following you on the HeartValveSurgery.com YouTube Channel. I get quite a lot of consolation from you with reference to valve illness and surgical procedure. I’m ready to have each mitral and tricuspid valve surgical procedure. However, right here is my dilemma and query for you. I used to be not too long ago identified with a tortuous esophagus (corkscrew formed). The cardiac surgeon mentioned that my esophagus shall be a complication as a result of he wants to make use of the transesophageal echocardiogram (TEE) digicam to carry out this surgical procedure. However, he can not insert the TEE by my esophagus. Have you ever heard of this earlier than? Have you learnt any consultants that I might contact about my query? Thanks, Lori”
Corkscrew Esophagus (Supply: New England Journal of Drugs)
As I had by no means heard of corkscrew esophagus earlier than, I wished to study extra about tortuous esophagus and supply Lori an skilled response. For that motive, I reached out to Dr. Marc Gerdisch, a number one coronary heart valve surgeon, that has efficiently handled over 100 sufferers within the HeartValveSurgery.com affected person group.
Dr. Marc Gerdisch Shortly Responds to Lori…
Only a few hours after sending Dr. Gerdisch the query about corkscrew esophagus, my inbox lit-up with this response from Dr. Gerdisch:
Corkscrew esophagus is a time period primarily based on x-ray photographs of the esophagus with distinction inside it. It seems to be like a corkscrew. Typically, there are two classes; achalasia and diffuse esophageal spasm (DES). They’re associated to discoordination of the esophageal muscle and considered attributable to an autoimmune situation that damages the nerves across the esophagus.
There are remedies that rely upon the kind, however they embody calcium channel blocking drugs, injected botulin toxin (Botox) into the muscle, and myotomy, which is a process to chop into the esophageal muscle to cease the spasm.
Dr. Marc Gerdisch
As for the TEE, I’d verify the character of the situation with respect to anatomy and severity. Folks with corkscrew esophagus routinely endure endoscopy, therefor they’ve probes handed by the esophagus. The priority is whether or not passing the TEE probe would threat harm to the esophagus. Unquestionably, it could be somewhat riskier than for somebody with out corkscrew esophagus. However, the excellent news is that she is conscious forward of time. I’d evaluate the pictures that made the analysis and talk about the potential for challenges passing the probe along with her gastroenterologist.
An possibility we now have used is to have a gastroenterologist current in the beginning of the case. They’ll first move the endoscope to visualise the trail and guarantee clean passage of the TEE probe. If for some motive a TEE probe can’t be positioned, we might depend on direct testing of the valve and “transthoracic” echocardiography.
If the operation had been carried out minimally invasively, the transthoracic echo probe might be positioned on the affected person’s chest in a regular trend, like we do when performing TAVR. If a sternotomy had been wanted, a probe will be put in a sterile sleeve after which positioned immediately on the guts on the conclusion of the process and the pictures are glorious.
Many Thanks Lori and Dr. Gerdisch!
I hope this helped Lori (and maybe you) study extra about corkscrew esophagus and coronary heart valve surgical procedure. On behalf of our affected person group, many because of Lori for her query and a particular because of Dr. Marc Gerdisch for taking the time to share his medical expertise, surgical practices and analysis with us.
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Carry on tickin!Adam