Transesophageal Echocardiography (TEE) in Cardiac Surgery: Complications, Limitations, and Clinical Considerations

Background Transesophageal echocardiography (TEE) has become an indispensable diagnostic and monitoring tool in cardiac surgery, yet its semi-invasive nature is associated with complications and limitations. Understanding these risks is crucial for safe clinical practice.  Objective To review the potential complications, contraindications, limitations, and pitfalls of TEE in cardiac surgery and to provide a balanced appraisal of its utility in perioperative management.  Methods Literature-based review of complications, contraindications, and limitations related to TEE, supported by evidence from large case series and guideline documents. Clinical data were synthesized from key published studies and institutional experiences.  Results Major complications of TEE are rare, ranging from 0.2% to 0.5% in diagnostic settings, with mortality below 0.01%. Intraoperative use increases complication risk (0.2–1.2%), including esophageal trauma, arrhythmias, airway obstruction, and hemodynamic compromise. Pediatric patients present additional risks due to anatomical constraints. Contraindications include esophageal pathologies and recent upper GI surgery. Limitations include restricted visualization of certain cardiac structures and artifacts that may mimic pathology.  Conclusion Despite its risks, TEE remains an essential perioperative tool in cardiac surgery. Awareness of its complications and limitations allows clinicians to optimize patient safety while benefiting from its diagnostic power.