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Transoesophageal echocardiogram

A transoesophageal echocardiogram is a test that uses ultrasound to produce moving, real-time images of your heart. The procedure involves passing an ultrasound sensor down into your oesophagus (the pipe that goes from your mouth to your stomach). It can check your heart’s structure and how well it functions, and can also be used during heart procedures to help guide your surgeon.

Unless you’re having it during heart surgery, the test will be done by a cardiologist (a doctor who specialises in heart conditions) or a sonographer. This is someone who is trained to carry out ultrasound scans. The procedure may not be quite as we describe here because it will be adapted to suit your individual needs.

A transoesophageal echocardiogram gives more detailed pictures of the inside of your heart and the valves than a standard echocardiogram.

There are lots of things to do with your heart that a transoesophageal echocardiogram can be used to check for. It’s important to be fully informed about why you’re having it so talk to whoever does your test if you have any questions.

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An image showing the ultrasound probe passed through the oesophagus to view the heart

Details

  • Preparation Preparing for transoesophageal echocardiogram

    A transoesophageal echocardiogram is usually done as a day-case procedure in hospital.

    Your doctor or sonographer will explain how to prepare for your procedure. For example, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. If you take any medicines regularly, you’ll probably be fine to do so on the morning of your appointment with a sip of water. It’s important to let your doctor know if you’re taking anticoagulants (medicines that help to prevent your blood clotting), such as warfarin.

    You will usually stay awake during the procedure although your doctor may give you a sedative. This relieves anxiety and helps you to relax.

    Your doctor or sonographer will discuss with you what will happen before, during and after your procedure, and any pain you might have. It’s important that you understand what will happen so you can give your consent to have the test. You may want to prepare questions in advance to ask about the risks and benefits so you feel fully informed.

  • Alternatives What are the alternatives to a transoesophageal echocardiogram?

    Alternatives to having a transoesophageal echocardiogram include the following.

    • Echocardiogram (transthoracic echocardiogram). This involves a doctor or sonographer moving an ultrasound sensor over your chest to get pictures of your heart. You may be able to have this procedure if you have difficulty swallowing the sensor in a transoesophageal echocardiogram. A standard echocardiogram produces less detailed images than a transoesophageal echocardiogram.
    • Cardiac MRI scan. MRI is a technique that uses powerful magnets, radio waves and computers to produce detailed images of the inside of your heart.
    • Radionuclide test. In this test, your doctor will inject a harmless, radioactive substance into your body. They will then use a camera to take pictures of your heart. The radioactive substance shows up as it travels through your heart and your doctor uses this to assess your heart function and blood flow.

    Talk with your doctor about which procedure is most suitable for you.

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  • The procedure What happens during transoesophageal echocardiogram?

    A transoesophageal echocardiogram usually takes about 20 minutes.

    You’ll be asked to undress to your waist and put on a hospital gown that opens at the front. You’ll also need to remove any dentures or dental plates if you have them.

    If you’re having a sedative, your doctor will usually give you this through a fine tube (cannula) into a vein in your arm.

    Your heart rhythm will be monitored throughout the procedure.

    You’ll be asked to lie on your left-hand side. Your doctor or sonographer will spray a local anaesthetic into the back of your throat to numb it, and place the sensor in your mouth. You’ll then be asked to swallow so the sensor can be passed into your oesophagus.

    The sensor will send out sound waves and pick up the returning echoes, which are converted into pictures of the inside of your heart. These are displayed on a monitor and are constantly updated, so the scan can show movement.

    The test isn't painful but it may feel uncomfortable when the sensor is passed into your oesophagus.

    An image showing the ultrasound probe passed through the oesophagus to view the heart
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  • Aftercare What to expect afterwards

    You’ll need to rest until the effects of the sedative have passed, which can take up to three hours. After that you can go home when you feel ready but you’ll need to arrange for someone to drive you. Sedation temporarily affects your coordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you’re in any doubt about driving, contact your motor insurer so you’re aware of their recommendations, and always follow your doctor or sonographer’s advice.

    Your doctor or sonographer may discuss the results of your transoesophageal echocardiogram with you after the procedure. Alternatively, your results may be sent to the doctor who requested your test, who will go through them with you at your next appointment.

  • Recovery Recovering from transoesophageal echocardiogram

    After a local anaesthetic, it may take several hours before the feeling comes back into your mouth and throat. Don’t try to eat or drink until you can swallow normally – this may take up to an hour.

  • Risks What are the risks?

    As with every procedure, there are some risks associated with a transoesophageal echocardiogram. We haven’t included the chance of these happening as they are specific to you and will vary depending on your circumstances. Ask your doctor or sonographer to explain how they apply to you.

    Side-effects

    Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. You may have a sore throat for a day or two after a transoesophageal echocardiogram. Your throat may also bleed a little.

    Complications

    Complications are when problems occur during or after the procedure. Complications of a transoesophageal echocardiogram can include:

    • damage to your teeth or dental work, such as crowns
    • damage or a tear to your oesophagus
    • an allergic reaction to the sedative, such as difficulty breathing or feeling sick
    • inhaling the contents of your stomach – this shouldn’t happen if you fast before the procedure

    For more information about the risks of a transoesophageal echocardiogram, speak to your doctor or sonographer.

  • FAQs FAQs

    What if I can’t swallow the sensor when I’m having a transoesophageal echocardiogram?

    Answer

    Your doctor will spray a local anaesthetic into the back of your throat before you have the procedure. This will make it easier for you to swallow the sensor.

    Explanation

    The sensor is very thin and shouldn’t be difficult to swallow. The local anaesthetic will help to stop your gagging reflex and your doctor will also give you a sedative to help you relax.

    If you have any concerns about the procedure, talk about them with your doctor or sonographer before the test. Tell your doctor if you’ve had previous surgery to your throat or neck, any problems swallowing or if you’ve ever coughed up blood. Your doctor may suggest that you have an alternative test.

    My doctor has recommended I have a transoesophageal echocardiogram. Why this and not a standard echocardiogram?

    Answer

    A transoesophageal echocardiogram produces more detailed pictures of your heart than a standard echocardiogram. This makes it more accurate for your doctor to diagnose certain problems with your heart. It’s also much better for investigating artificial heart valves and looking for a blood clot in your heart.

    Explanation

    In a routine echocardiogram, your doctor or sonographer will move an ultrasound sensor over your chest. Although it produces good pictures of your heart, sound waves have to pass through skin, fat, bone and air in your ribcage and lungs. This means that the pictures aren’t as clear as in a transoesophageal echocardiogram, where the sensor is placed close to the back of your heart.

    How will my doctor know if there is a problem with my heart?

    Answer

    A transoesophageal echocardiogram produces detailed pictures of the structures inside your heart, which can help your doctor to identify any problems.

    Explanation

    To check for heart valve disease, your doctor will look at the shape of your valves and how they are moving. They will also look for signs of calcium deposits, which are a common cause of narrowed valves. By measuring how fast your blood is flowing, your doctor will be able to see if your valves have become narrow or are leaking.

    If you have an infection of your heart valves, the transoesophageal echocardiogram may show this. To check how well your heart is pumping blood, your doctor will look at the size, thickness and function of your left ventricle. This is one of the lower chambers of your heart, which pumps blood that contains oxygen around your body. Checking the size of your left ventricle and how well it’s working can show whether there is a problem with your heart’s pumping ability.

    What will happen after I get the results of my transoesophageal echocardiogram?

    Answer

    Your doctor will help you to choose the best course of action or treatment. This will be based on the results of your transoesophageal echocardiogram, together with any other tests you have. Depending on the results, you may need to have treatment, such as medicines or surgery.

    Explanation

    A transoesophageal echocardiogram is just one test that doctors use to assess how your heart is working. You may have other tests such as an electrocardiogram (ECG), a chest X-ray, blood and urine tests.

    Your doctor may diagnose a problem with your heart using the results of all these tests. However, your transoesophageal echocardiogram may also rule out a problem with your heart, or show you need further tests before a diagnosis can be made.

    If tests do show up a problem with your heart, your doctor will discuss your treatment options with you. Depending on what the problem is, your doctor may advise you to take medicines or have surgery.

  • Resources Resources

    Further information

    Sources

    • Echocardiography. The Merck Manuals. www.merckmanuals.com, published December 2012
    • Echocardiography. PatientPlus. www.patient.co.uk/patientplus, reviewed 20 February 2012
    • Patient information leaflet: trans-oesophageal echocardiography. British Society of Echocardiography. www.bsecho.org, accessed 24 July 2014
    • A minimum dataset for a standard transoesophageal echocardiogram. British Society of Echocardiography. www.bsecho.org, published 2010
    • What is transoesophageal echocardiography? National Heart Lung and Blood Institute. www.nhlbi.nih.gov, published 7 March 2012 
    • Patient information leaflet: transthoracic echocardiography. British Society of Echocardiography. www.bsecho.org, accessed 22 July 2014
    • Patient information leaflet: contrast echocardiography. British Society of Echocardiography. www.bsecho.org, accessed 23 July 2014
    • Cardiac imaging tests. The Merck Manuals. www.merckmanuals.com, published December 2012
    • Radionuclide imaging. The Merck Manuals. www.merckmanuals.com, published December 2012
    • Transoesophageal echocardiography (TEE). American Heart Association. www.heart.org, published 20 June 2012
    • Ultrasound – carotid. Radiological Society of North America. www.radiologyinfo.org, published 27 August 2013
    • Aortic stenosis. PatientPlus. www.patient.co.uk/patientplus, reviewed 30 October 2012
    • Heart anatomy. Medscape. www.emedicine.medscape.com, published 19 March 2013
    • Cardiac tests. Medscape. www.emedicine.medscape.com, published 9 December 2013
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