Transesophageal Echocardiography

Why is this test being ordered?

The advantage of transesophageal echocardiography (TEE) over transthoracic echocardiography (TTE) is improved image quality, especially of structures that are difficult to view through the chest wall. The explanation for this is the heart rests directly upon the esophagus leaving only millimeters in distance that the ultrasound beam has to travel. This reduces the attenuation (weakening) of the ultrasound signal, generating a stronger return signal and clearer image. Comparatively, transthoracic ultrasound must first traverse skin, fat, ribs and lungs before reflecting off the heart and back to the probe before an image can be created.

In adults, several structures can be evaluated and better imaged with the TEE, including the valves of the heart, both atria, the atrial septum, the left atrial appendage, cardiac masses and tumors, and the aorta.  Frequently this procedure is ordered to evaluate the severity of mitral regurgitation (leak in your mitral valve) as well as detailed anatomy of the mitral valve (please see image below) and whether the valve is amenable to being fixed rather than replaced if surgery is required.  Unfortunately a stroke can result from blood clots moving from the heart to the brain and a TEE may be ordered to check for possible cardiac sources.  Blood clots in the left atrial appendage (a small pocket-like area in the left atrium at risk for clot formation especially for patients in a cardiac rhythm called atrial fibrillation), a hole in the heart called a patent foramen ovale (PFO) which may allow blood clots to cross from the right side of your body to the brain, and cholesterol plaqueing in your aorta (the main artery which takes blood from the heart to the rest of the body including the brain) may all be potential causes of a stroke and the TEE investigates these possible sources in excellent detail.  The other most frequent indication for this procedure is to evaluate for possible infections of the heart valves (endocarditis). 

TEE of posterior mitral valve prolapse with associated mitral regurgitation.

How does it get set up?

When your doctor decides with you that you need to have a transesophageal echocardiogram, a time is scheduled at the hospital for the procedure.  Our office schedulers will arrange a time at the hospital that is convenient for you. 

How to prepare for the test?

We ask that you consume nothing by mouth (NPO) after midnight prior to the procedure other than prescribed medication with a small quantity of water.  Diabetic patients:  If on insulin: Take ½ dose of your prescribed dose the night before and morning of the test. If taking oral (by mouth) diabetic medications: Take NO oral diabetic medications on the day of the procedure.  After two hours after the completion of the procedure, you will be able to eat and drink, and at that point diabetic patients can return to the normal doses of your diabetic medications.  We ask that you come with someone that can drive you home or least that you have a way of getting home without driving yourself home because of the effect of sedative medication that you will receive.

What happens at the procedure?

When you arrive at the hospital on the day of the transesophageal echocardiogram, you will be registered and taken to a procedure room.  You will be greeted by a nurse who will review your medical history and prepare you for the procedure.  A hospital gown top will be given to you for you to change into.  EKG electrodes will be placed on your chest so your rhythm can be followed.  You will have your oxygen level and blood pressure followed.  An intravenous (IV) will be placed in a vein of one of your arms.  One of the cardiology specialists from our practice will then greet you and review the procedure and ask you to sign a consent form.  Any friends and family that you have brought with you will be asked to adjourn to waiting room.  Your throat will be numbed with lidocaine jelly and/or benzacaine spray to eliminate your gag reflex.  You will be asked to remove any dentures or removal teeth.  We will then ask you to roll onto your left side and we will start sedating you with IV medication.  The goal of sedation is to make you sleepy and comfortable but not unconscious.  The small camera/probe will then be passed and you will be asked to swallow it and go back to sleep.  The next part of taking pictures of your heart will last on average from 10 to 20 minutes.  Your will then shortly awaken and be observed until you have recovered and can be safely discharged home accompanied by your friends or family members.

The Results?

Our cardiologists read the echocardiographic images as the study is being done and discuss the results with you and your family shortly after the procedure has been completed prior to your leaving the hospital.  Additionally your referring physician will always receive a detailed summary of the test as well as in certain situations being called directly with the results.