What is the mechanism of aortic injury by TEE probe ?
It is purely a mechanical complication . The dissected/aneurysmal segment may encroach the esophagus .The TEE probe if faces any resistance at lower esophagus , the procedure is to be abandoned .The false lumen shares a intimate spacious relationship with esophagus and the probe can delicately hug the false lumen , can lift it accelerating the tear. It is wise to realise coughing , retching or vomiting may amplify the frictional force between esophagus aorta and the probe .
I would conclude the risk of aortic rupture is negligible . If gently performed TEE would remain a simple , cost effective , vital bed side investigation inmost cases of suspected aortic dissection.