Transesophageal Echocardiography

What is transesophageal echocardiography?

Transesophageal echocardiography (TEE) is a test that produces pictures of your heart. TEE uses high-frequency sound waves (ultrasound) to make detailed pictures of your heart and the arteries that lead to and from it. Unlike a standard echocardiogram, the echo transducer that produces the sound waves for TEE is attached to a thin tube that passes through your mouth, down your throat and into your esophagus. Because the esophagus is so close to the upper chambers of the heart, very clear images of those heart structures and valves can be obtained. 

Why do people have TEE?

Doctors use TEE to find problems in your heart’s structure and function. TEE can give clearer pictures of the large artery leaving the heart (ascending aorta), the upper chambers of the heart, and the valves between the upper and lower chambers of the heart, than standard echocardiograms.

The detailed pictures provided by TEE can help your health care team see:

• The size of your heart and how thick its walls are.
• How well your heart is pumping.
• If there is abnormal tissue around your heart valves that could indicate bacterial, viral or fungal infections or cancer.
• Defects that can cause heart murmurs.
• If blood is leaking backward through your heart valves (regurgitation) or if your valves are stiff, narrowed or blocked (stenosis).
• If blood clots are in the chambers of your heart, in particular the upper chamber, such as those caused by atrial fibrillation.

TEE is often used to provide information during surgery to repair heart valves, a tear in the aorta or congenital heart lesions. It’s also used during surgical treatment for endocarditis, a bacterial infection of the inner lining of the heart and valves.

What are the risks of TEE?

The few risks of TEE involve passing the probe from your mouth down into your throat and esophagus. You will get medicines before the test to make you calm and to numb your throat. But you may still feel like gagging. You may have a sore throat for a day or two after the test. In less common cases, people who have a TEE may have an allergic reaction to the medications or they may have minor bleeding in their esophagus.

How do I prepare for TEE?

Check with your health care provider. You may be told not to have alcoholic drinks for a few days before the test,  and not to eat or drink anything for a certain amount of time before the test. Since you may receive a sedative to help you stay calm, someone should drive you home after the test.

What happens during TEE?

A specially trained technician, called a sonographer, performs the TEE. Your heart doctor (cardiologist) reads the results.

• The technician sprays your throat with a medicine to numb it and suppress the gag reflex. You’ll lie on a table.
• A nurse puts an IV (intravenous line) in your arm and gives you medicine to help you stay calm.
• The technician then places small pads (electrodes) on your chest. The electrodes are attached by wires to a machine that will record your electrocardiogram (ECG) to track your heartbeat.
• Then a thin, flexible tube (probe) is gently guided through your mouth and down your throat. You’ll need to  swallow as it goes down.
• A transducer on the end of the probe sends sound waves to your heart and collects the echoes that bounce back. These echoes become pictures that show up on a video screen.
• When the TEE is complete, the probe, IV and electrodes are removed and you will be monitored until you are fully awake. Then you can usually get up, get dressed and be taken home from the clinic or hospital.

What happens after TEE?

Your throat may be numb for a short time. Don’t eat or drink anything until the numb feeling goes away — you could choke.

• You may have a little trouble swallowing right after the test, but this will go away within a few hours.
• It’s common to have a sore throat for a day or two after the test.
• Because of the sedative you get during the procedure, someone should drive you home from the test. You should be able to drive in 24 hours.

What should I watch for?

Call your health care professional if your sore throat gets worse or doesn’t go away after a few days.