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“Is Corkscrew Espophagus A Complication During Heart Valve Surgery?” asks Lori

Written By: Adam Pick, Patient Advocate, Author & Website Founder
Medical Expert: Marc Gerdisch, MD, Chief of Cardiac Surgery, Franciscan Health
Published: August 11, 2024

I just received a very interesting question from Lori about heart valve surgery and corkscrew esophagus, also known as tortuous esophagus.

In her email, Lori asked me, “Hi Adam, I have been following you at the HeartValveSurgery.com YouTube Channel. I get a lot of comfort from you with regards to valve disease and surgery. I am waiting to have both mitral and tricuspid valve surgery. But, here is my dilemma and question for you. I was recently diagnosed with a tortuous esophagus (corkscrew shaped). The cardiac surgeon said that my esophagus will be a complication because he needs to use the transesophageal echocardiogram (TEE) camera to perform this surgery. But, he cannot insert the TEE through my esophagus. Have you heard of this before? Do you know any experts that I could contact about my question? Thanks, Lori”

Corkscrew Esophagus Corkscrew Esophagus (Source: New England Journal of Medicine)

As I had never heard of corkscrew esophagus before, I wanted to learn more about tortuous esophagus and provide Lori an expert response. For that reason, I reached out to Dr. Marc Gerdisch, a leading heart valve surgeon, that has successfully treated over 100 patients in the HeartValveSurgery.com patient community.

Dr. Marc Gerdisch Quickly Responds to Lori…

Just a few hours after sending Dr. Gerdisch the question about corkscrew esophagus, my inbox lit-up with this response from Dr. Gerdisch:

Corkscrew esophagus is a term based on x-ray images of the esophagus with contrast inside of it. It looks like a corkscrew. Generally, there are two categories; achalasia and diffuse esophageal spasm (DES). They are related to discoordination of the esophageal muscle and thought to be caused by an autoimmune condition that damages the nerves around the esophagus.

There are treatments that depend on the type, but they include calcium channel blocking medicine, injected botulin toxin (Botox) into the muscle, and myotomy, which is a procedure to cut into the esophageal muscle to stop the spasm.

Dr. Marc Gerdisch

As for the TEE, I would ascertain the nature of the condition with respect to anatomy and severity. People with corkscrew esophagus routinely undergo endoscopy, therefor they have probes passed through the esophagus. The concern is whether passing the TEE probe would risk injury to the esophagus. Unquestionably, it would be a little riskier than for someone without corkscrew esophagus. But, the good news is that she is aware ahead of time. I would review the images that made the diagnosis and discuss the potential for challenges passing the probe with her gastroenterologist.

An option we have used is to have a gastroenterologist present at the beginning of the case. They can first pass the endoscope to visualize the path and ensure smooth passage of the TEE probe. If for some reason a TEE probe cannot be placed, we would rely on direct testing of the valve and “transthoracic” echocardiography.

If the operation were performed minimally invasively, the transthoracic echo probe could be placed on the patient’s chest in a standard fashion, like we do when performing TAVR. If a sternotomy were needed, a probe can be put in a sterile sleeve and then placed directly on the heart at the conclusion of the procedure and the images are excellent.

Many Thanks Lori and Dr. Gerdisch!

I hope this helped Lori (and perhaps you) learn more about corkscrew esophagus and heart valve surgery. On behalf of our patient community, many thanks to Lori for her question and a special thanks to Dr. Marc Gerdisch for taking the time to share his clinical experience, surgical practices and research with us.

Written by Adam Pick
- Patient & Website Founder

Written by Adam Pick - Patient & Website Founder

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.