A Transesophageal Echocardiogram (TEE) is a specialized medical imaging test that uses high-frequency sound waves to create detailed pictures of the heart’s structure and function. This diagnostic tool is a type of ultrasound that gathers images from inside the body rather than from the chest wall. The TEE provides a much clearer view of the heart’s chambers, valves, and surrounding blood vessels, allowing physicians to detect issues that less invasive tests might miss.
Why Doctors Use a Transesophageal Approach
A standard echocardiogram (TTE) involves placing a transducer on the chest surface. Sound waves must pass through skin, muscle, bone, and lung tissue, which scatters the waves and results in lower-resolution pictures. The transesophageal approach overcomes this limitation by guiding a small ultrasound transducer down the esophagus, the tube connecting the mouth to the stomach.
The esophagus runs directly behind the heart, placing the transducer extremely close to the heart’s upper chambers and valves. This proximity allows the ultrasound waves to travel a shorter distance, producing sharper and more detailed images. This technical advantage is important when evaluating posterior structures of the heart, such as the left atrium and sections of the aorta.
The transesophageal route is often necessary when a patient’s body habitus, such as obesity or certain lung conditions, interferes with TTE image clarity. Placing the probe internally ensures that obstructions like ribs and air-filled lung tissue do not compromise the diagnostic quality of the scan.
Conditions TEE Helps Diagnose
The high-resolution images provided by a TEE are required to confirm or rule out specific structural problems and infections within the heart. One frequent use is searching for blood clots, particularly in the left atrial appendage, a common site for clot formation in patients with atrial fibrillation. Discovering these clots is a mandatory step before procedures like electrical cardioversion, which could dislodge a clot and cause a stroke.
TEE is highly effective for the detailed evaluation of heart valves, which control blood flow. It accurately assesses the severity of conditions like valve regurgitation, where blood leaks backward, or stenosis, where a valve becomes narrowed. This detail is also necessary for assessing artificial heart valves or diagnosing infective endocarditis, an infection of the heart’s inner lining. Infective endocarditis is identified by looking for vegetations, which are small masses of bacteria and blood components on the valve leaflets.
The test provides visualization of the aorta, the body’s main artery, especially the section exiting the heart. This allows physicians to look for aortic dissection, a potentially life-threatening tear in the inner layer of the aortic wall. TEE is also a preferred method during certain cardiac surgeries to monitor heart function and valve repair success.
Step-by-Step Guide to the TEE Procedure
Preparation begins with the patient lying on an examination table, usually on their left side. An intravenous (IV) line is started to administer sedative medication and fluids throughout the procedure. Before the probe is inserted, the back of the throat is numbed using a local anesthetic spray to minimize the gag reflex.
The medical team, including a cardiologist and often an anesthesiologist, places monitoring equipment on the patient. This equipment continuously tracks the heart rate, blood pressure, and oxygen saturation levels throughout the exam. A protective mouthguard, known as a bite block, is inserted to prevent the patient from accidentally biting the probe.
Once the patient is adequately relaxed from the sedation, the cardiologist gently guides the thin, flexible probe into the mouth and down the esophagus. Patients are often awake but drowsy, and they may be asked to swallow slightly to help the probe pass easily.
The imaging portion of the procedure is relatively quick, typically lasting between 15 and 30 minutes. The cardiologist maneuvers the probe to capture various angles and views of the heart structures, displaying the moving images on an ultrasound monitor. Once the necessary pictures are obtained, the probe is carefully removed, and the patient is moved to a recovery area.
Preparing for the Test and Recovery
To ensure the esophagus is clear and to prevent complications from sedation, patients are required to fast before the test. This means no eating or drinking for at least six to eight hours prior to the scheduled procedure time. Necessary medications can generally be taken with only a small sip of water, but patients must review their current medications with their physician beforehand.
Because the procedure involves sedation, the patient is unable to drive or operate heavy machinery for at least 18 to 24 hours afterward. It is mandatory to arrange for a responsible adult to transport the patient home and to stay with them for several hours following the discharge.
Immediately after the TEE, the patient is observed in a recovery area until the effects of the sedative wear off and vital signs are stable. A common side effect is a mild sore throat, which may last for a day or two. Patients must not eat or drink anything until the numbing effect of the throat spray has completely disappeared, typically taking one to two hours, to prevent the risk of choking or aspiration.
While a TEE is generally a safe procedure, there are rare, potential risks associated with any invasive test. These include possible injury to the teeth, throat, or esophagus during probe insertion, or a reaction to the sedating medications.