A transesophageal echocardiogram (TEE) is a specialized ultrasound test that uses high-frequency sound waves to create moving, detailed pictures of your heart. Unlike a standard echocardiogram where the transducer is placed on the chest, the TEE probe is a thin, flexible tube guided down the esophagus, the tube connecting the mouth to the stomach. This unique approach is necessary because the esophagus runs directly behind the heart, allowing the sound waves to capture clear images without interference from the ribs, lung tissue, or skin. The procedure is typically performed to look closely at heart valves, assess the function of the heart’s upper chambers, or check for blood clots that may not be visible with external imaging.
Preparing for the Transesophageal Echocardiogram
Preparing for the TEE focuses primarily on ensuring your stomach is completely empty before the procedure. You will be required to fast, meaning you cannot eat or drink anything, for a period of six to eight hours prior to your scheduled test. This instruction is important because you will receive sedation, and having an empty stomach significantly reduces the risk of aspiration, which is the accidental inhalation of stomach contents into the lungs.
The other major component of preparation involves managing your medications and arranging for post-procedure transportation. Your physician will provide specific guidance on which medications to take or skip on the day of the exam. Generally, necessary daily medications can be taken early that morning with only a small sip of water. Because you will receive sedating medication, your coordination and judgment will be temporarily impaired. Therefore, a responsible adult must accompany you to the appointment, wait for you, and drive you home afterward.
What Happens During the TEE Procedure
Upon arrival, your experience begins with a brief check-in and preparation phase. A nurse will place an intravenous (IV) line, typically in your arm or hand, which will be used later to administer sedating medication. You will be asked to change into a gown and lie on an examination table, usually positioned on your left side, which helps optimize the imaging angle. Small adhesive patches, called electrodes, will be placed on your chest to connect you to an electrocardiogram (ECG) monitor.
Continuous monitoring is a standard part of the procedure, tracking your heart rhythm, blood pressure, and oxygen saturation levels throughout the test. To make the insertion of the probe more comfortable, your throat will be treated with a topical anesthetic spray, which temporarily numbs the area and helps to suppress the gag reflex. After this, the sedative will be administered through your IV line, making you relaxed or drowsy for the duration of the test.
Once the sedation has taken effect, a small protective guard will be placed in your mouth to protect your teeth and the instrument. The cardiologist will then gently guide the flexible, lubricated probe down your throat and into your esophagus. This thin tube, which has the ultrasound transducer at its tip, does not interfere with your ability to breathe, as it enters the esophagus and not the trachea (windpipe). The cardiologist will carefully maneuver the probe to obtain detailed, high-resolution images of the heart’s structures, including the valves and chambers. This active imaging portion of the TEE is brief, typically lasting only about 15 to 30 minutes, after which the probe is carefully removed.
Immediate Post-Procedure Care and Discharge
After the TEE probe is removed, you will be moved to a recovery area for monitoring while the effects of the sedative begin to wear off. The recovery period usually lasts between one and two hours, during which the medical staff will continue to observe your blood pressure and heart rate until you are sufficiently alert. A very common side effect is a mild sore throat or hoarseness, caused by the probe and the topical anesthetic irritation, but this usually resolves within a day or two.
You must not attempt to eat or drink anything until the numbing sensation in your throat has fully disappeared and your swallowing reflex is confirmed to be normal. This safety measure typically takes about two hours post-procedure, as swallowing while your throat is numb can lead to choking. The nurse will often have you try a small sip of water before clearing you to resume a light diet.
Due to the sedation, strict guidelines must be followed for the next 24 hours to ensure your safety. You are not permitted to drive a car, operate any heavy machinery, consume alcoholic beverages, or make important legal decisions. Before leaving the facility, the staff will review all these discharge instructions with your accompanying adult. The final results of the TEE are usually communicated to you by your referring physician in a follow-up appointment, once the cardiologist has thoroughly reviewed the images and prepared the official report.