Transesophageal echocardiogram

What is a Transesophageal Echocardiogram?

A Transesophageal Echocardiogram (TEE) is a test in which images of the heart are obtained using a special ultrasound probe, which is introduced into the esophagus (through the mouth) under sedation.

When there are still doubts about the Transthoracic Echocardiogram, your doctor will prescribe a Transesophageal Echocardiogram (TEE), as this test allows certain structures of the heart to be better visualized.

The whole procedure takes about an hour. However, the ultrasound probe is usually only inserted for around 10 to 15 minutes.

What is the examination for? What are the indications?

It is particularly important in patients in whom transthoracic echocardiography does not provide adequate images.

It is indicated for the assessment of posterior cardiac structures which, due to the normal position of the heart in the chest cavity, are far from the chest wall and closer to the esophagus.

The situations that most often require a transesophageal echocardiogram are the clarification of valvular and aortic lesions, the search for cardiac embolic sources, the diagnosis of endocarditis and certain congenital heart diseases. It is also a test widely used in intraoperative cardiac surgery or percutaneous structural intervention.

How is a transesophageal echocardiogram performed?

The Transesophageal echocardiography is a special form of echocardiography performed through the esophagus. The esophagus is very close to the heart, so it is possible to see in great detail certain areas of the heart that are less accessible to transthoracic echocardiography (through the front of the chest), which you may have had before.

This is a semi-invasive test, similar to digestive endoscopy. It is carried out in a dedicated environment (echocardiography room) by a multidisciplinary team that is highly trained in this area - a cardiologist, a cardiopneumology technician and a nurse.

You should tell the professionals if you have any oesophageal diseases, if you have had surgery or treatment in this area, or if you have difficulty swallowing. You should also tell them if you have any allergies, any coagulation disorders or if you are taking anticoagulant medication.

It is essential that you fast (liquids and solids) for at least 6 hours before the procedure. You will also be asked to remove any dentures or mobile dental devices from your mouth immediately before the procedure begins.

It is essential that you give your informed consent (without this signed document the test will not be carried out) and, if you agree to undergo the test, you must also inform the team of the presence of any of the situations described.

A vein will be channeled into your arm to administer medication, namely a mild sedative, which will make you feel more comfortable. The doctor will locally anesthetize your throat with an anesthetic spray/gel, after which a 1 cm diameter probe will be gently inserted into your esophagus for a few minutes to take the desired images. Throughout the procedure your vital signs will be monitored (oxygen level, blood pressure and reaction to medication).

Benefits

The aim of this test is to visualize the heart and blood flow more completely and with better quality than transthoracic echocardiography, allowing for a more accurate diagnosis of various cardiovascular diseases.

Are there any risks? 

• The effects of sedation usually wear off within a few hours.
• The risks associated with performing a TEE are rare, but they do exist. For a few days after the examination, you may notice some discomfort in the throat (“scratchy” throat, hoarseness) associated with the passage of the probe.
• Rare possible risks also include inflammatory/infectious processes, perforation of the esophagus, esophageal bleeding, cardiac arrhythmias and, exceptionally, fatal situations.

Care after TEE

• You can't eat or drink for about two hours after the procedure, as your throat may still be anesthetized.
• You will not be able to drive for the rest of the day, and it is recommended that you do not sign any legal documents on the day of the examination.
• You will need to arrange for someone to drive you home after the procedure, as you may feel numb from the sedative.
• The examination report will be made available to you later, after the images have been analyzed.

How should you prepare for the examination?

• Fast (liquids and solids) for at least 6 hours before the procedure.
• Some medications may need to be suspended 1-2 days before the examination, particularly anticoagulants (you will be contacted by our team).
• You must be accompanied as you will not be able to drive after the examination.

IT IS EXTREMELY IMPORTANT THAT YOU COMPLY WITH THE PREPARATION FOR THE EXAM

On the day of the exam:

• Bring previous and recent tests - for example: Echocardiogram, Electrocardiogram (ECG), Stress test, Catheterization, Coronary angiography, Surgical report (if you have had surgery), other reports, analyses.
• Bring all medication.
• Arrive 30 minutes before the scheduled time.
• Go to Floor Zero - External Consultation - Special Exams wing.