Ramalingam G, et al. - Via a one-year, multicenter, prospective audit of all patients having a peri-operative transoesophageal echocardiography (TOE) examination, researchers assessed the rate and severity of complications related to peri-operative TOE in anesthetized cardiology and cardiac surgical patients. A major complication that caused either palatal injury or gastro-esophageal disruption was seen in 17 patients out of 22,314 examinations. Seven deaths were recorded through the study period that were directly linked to these complications. A high probability of death after developing a complication was seen, and it was higher vs previously reported data. However, most complications happened in patients with no known risk factors for TOE associated gastro-esophageal injury, so clinicians and departments should review procedural guidelines, particularly for probe insertion methods, along with the material discussed with patients when risks and benefits of these examinations are explained. This was the first and largest study to prospectively investigate major peri-operative TOE-related complications in anaesthetized patients in the cardiac surgical, cardiac catheter laboratory and cardiac critical care settings.