Written By: Adam Decide, Affected person Advocate, Writer & Web site Founder
Medical Skilled: Marc Gerdisch, MD, Chief of Cardiac Surgical procedure, Franciscan Well being
Printed: August 11, 2024
I simply acquired a really attention-grabbing query from Lori about coronary heart valve surgical procedure and corkscrew esophagus, also referred to 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 on the subject of 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 lately identified with a tortuous esophagus (corkscrew formed). The cardiac surgeon stated that my esophagus will probably be a complication as a result of he wants to make use of the transesophageal echocardiogram (TEE) digital camera to carry out this surgical procedure. However, he can’t insert the TEE by means of my esophagus. Have you ever heard of this earlier than? Have you learnt any consultants that I might contact about my query? Thanks, Lori”
As I had by no means heard of corkscrew esophagus earlier than, I wished to be taught extra about tortuous esophagus and supply Lori an skilled response. For that cause, 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 neighborhood.
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 based mostly on x-ray photographs of the esophagus with distinction within it. It appears to be like 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 therapies that depend upon the sort, however they embrace calcium channel blocking medication, injected botulin toxin (Botox) into the muscle, and myotomy, which is a process to chop into the esophageal muscle to cease the spasm.
As for the TEE, I’d confirm the character of the situation with respect to anatomy and severity. Folks with corkscrew esophagus routinely bear endoscopy, therefor they’ve probes handed by means of the esophagus. The priority is whether or not passing the TEE probe would danger damage to the esophagus. Unquestionably, it could be a little bit riskier than for somebody with out corkscrew esophagus. However, the excellent news is that she is conscious forward of time. I’d assessment the photographs that made the analysis and talk about the potential for challenges passing the probe along with her gastroenterologist.
An choice we’ve got used is to have a gastroenterologist current at the start of the case. They will first move the endoscope to visualise the trail and guarantee clean passage of the TEE probe. If for some cause a TEE probe can’t be positioned, we might depend on direct testing of the valve and “transthoracic” echocardiography.
If the operation have been carried out minimally invasively, the transthoracic echo probe could possibly be positioned on the affected person’s chest in an ordinary vogue, like we do when performing TAVR. If a sternotomy have been wanted, a probe might be put in a sterile sleeve after which positioned immediately on the center on the conclusion of the process and the photographs are wonderful.
Many Thanks Lori and Dr. Gerdisch!
I hope this helped Lori (and maybe you) be taught extra about corkscrew esophagus and coronary heart valve surgical procedure. On behalf of our affected person neighborhood, many due to Lori for her query and a particular due to Dr. Marc Gerdisch for taking the time to share his scientific expertise, surgical practices and analysis with us.
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Carry on tickin!
Adam