What is a TEE? An echocardiogram is a test that uses ultrasound waves to examine the heart. A transesophageal echocardiogram, or TEE, is an echocardiogram that is done from inside the esophagus (the tube leading from the mouth to the stomach). Because the esophagus lies just behind the heart, the TEE provides much clearer images of the heart than a standard echocardiogram, which is performed from outside the chest.
How Does the TEE Work? A long probe (flexible tube) about the width of a little finger is inserted into the mouth and down the esophagus. A small transducer at the tip of the probe sends ultrasound waves that reflect (echo) off the various parts of the heart. The echoes are converted into moving images of the heart. The images show the actual shape and movement of the different heart structures and the flow of blood through the heart chambers and valves. The images are displayed on a television screen, and can be recorded on videotape.
Why is the TEE Done? Because it gives images that are sharp and clear, the TEE is generally performed when doctors want to examine hard-to-see structures of the heart. Here are some situations where a TEE may be done:
- To detect blood clots or masses inside the heart. To assess the severity of some valve defects. To examine prosthetic (artificial) heart valves. To evaluate holes between heart chambers. To detect infection of the heart valves. To diagnose a dissection (a tear) in the lining of the aorta (the body's main artery).
- When the standard echocardiogram is of poor quality or inadequate (such as in people who are obese or have chronic lung disease).
Preparing for the Test Do not eat or drink for six hours before the procedure to make sure that your stomach is empty. You may have sips of water to swallow your medications. If the test is done as an outpatient, have someone drive you to the hospital or clinic. Also, arrange to have someone drive you home after the test. Do not plan to drive yourself home, as you may be drowsy. Be sure to tell the doctor if you have a problem swallowing or if you have any conditions involving your esophagus or stomach.
Also, tell the doctor or nurse if you have allergies to medications, especially sedatives (medicines that help you relax). Before the test, you'll be given an explanation of the procedure, potential benefits and possible risks. Feel free to ask questions or share concerns you may have. You'll then be asked to sign a consent form. If you wear dentures or oral prostheses, you will need to remove them, as they may interfere with the test. An intravenous (IV) line will be inserted into a vein in your arm to allow injection of medications, such as sedatives or antibiotics.
What Happens During the Test? TEE is performed at a hospital, clinic, or test center, often as an outpatient. When you arrive for the test, you will change into a hospital gown and be taken to the procedure room. You will be asked to lie on your left side. Your throat is sprayed with an anesthetic to numb it. You may be given a low dose of a sedative through the IV line in your arm to help you relax. You may also be given antibiotics to help prevent an infection.
The doctor gently inserts the probe into your mouth. As you swallow, the tube is slowly directed into the esophagus. You may gag when the probe first enters the esophagus and you may feel the probe moving, but the procedure is generally not painful. The transducer is positioned in the esophagus just behind the heart, where high quality images can be recorded. With the help of control knobs, the doctor can move the tip of the probe up and down and sideways. This makes it possible to view various parts of the heart from different angles.
Your heart rate, blood pressure, and oxygen level are carefully monitored throughout the test. Suction may be needed to clear secretions from your mouth. You may also be given oxygen. The test usually takes between 15 and 20 minutes. You should allow one to two hours from your arrival to the time you can leave.
After Your TEE If you are given a sedative, have someone drive you home. Do not drive for 12 hours. Do not eat or drink for about an hour, or until your throat is no longer numb. After the test, your throat may be slightly sore. If so, you may soothe it with cold drinks and lozenges (once the hour has passed). Be sure to report unusual symptoms, such as difficulty in swallowing, shortness of breath, chest pain, bleeding or fever.
Is the TEE Safe? The TEE is a procedure that requires the insertion of a probe into the body, it therefore has some risk. The risk is small, however, and the TEE is considered a relatively safe procedure. Possible complications may include: breathing problems, abnormal heart rhythms, infection of the heart valves, reaction to sedatives, and bleeding. Rarely, the TEE may cause perforation (piercing) of the esophagus. To learn about your particular risk, discuss the matter with your doctor.
What Are the Benefits? The TEE provides images of the heart that often are much clearer than with a standard echocardiogram. The information gained from the TEE test helps your doctor make an accurate diagnosis and develop a treatment plan that's best for you.
Your Test Results The doctor conducting the test may be able to give you preliminary test results before your leave. Or your own doctor will discuss the test results with you during a future office visit.