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Transoesophageal echocardiogram

A transoesophageal echocardiogram is a test that uses ultrasound to produce moving, real-time images of your heart. It can show the structure of your heart and how well it’s working. A surgeon can also use it as a guide if you’re having an operation on your heart.

Unless you’re having it during heart surgery, a cardiologist (a doctor who specialises in heart conditions) may carry out the test. Alternatively, a sonographer (a technician who’s trained to use ultrasound) may do the procedure. They’ll adapt your care depending on your individual needs, so it might not be exactly as we describe here.

This topic is about a type of echocardiogram called a transoesophageal echocardiogram. We have a separate topic on transthoracic echocardiogram.

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

Details

  • About About transoesophageal echocardiogram

    In a transoesophageal echocardiogram, your doctor or sonographer will pass an ultrasound probe into your oesophagus. This is the pipe that goes from your mouth to your stomach. The procedure gives more detailed pictures of the inside of your heart and the valves than a transthoracic echocardiogram.

    A transoesophageal echocardiogram can check for lots of different things to do with your heart. If you’re unsure why you’re having one or if you have any other questions, ask your doctor.

  • Preparation Preparing for transoesophageal echocardiogram

    A transoesophageal echocardiogram is usually done as a day-case procedure in hospital. This means you have the test and go home the same day.

    Your doctor or sonographer will explain how to prepare for your procedure.

    You might be asked not to eat or drink anything for about six hours before you have the procedure. If you’re taking any medicines, you’ll probably be fine to do so on the morning of your appointment with a sip of water. But check with your doctor. They should have asked you before the test if you’re taking any medicines that help to prevent your blood clotting, such as warfarin.

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

    You may be asked to sign a form to give your consent for the transoesophageal echocardiogram to go ahead. Being fully informed can help you feel more at ease about what will happen, so if you have any questions about the procedure, ask your doctor. If you’re not sure you want to have the transoesophageal echocardiogram, you can take more time to decide.

  • Alternatives What are the alternatives to a transoesophageal echocardiogram?

    Alternatives to having a transoesophageal echocardiogram include the following.

    • Echocardiogram (transthoracic echocardiogram – TTE). This involves a doctor or sonographer moving an ultrasound sensor over your chest to get pictures of your heart. You might be able to have this procedure if you have difficulty swallowing the sensor for a transoesophageal echocardiogram. But a standard echocardiogram produces less detailed images than a transoesophageal echocardiogram.
    • Cardiac MRI scan. MRI uses powerful magnets, radio waves and computers to produce detailed images of the inside of your heart.
    • Cardiac CT scan. This uses X-rays to create a three-dimensional image of your heart.
    • Radionuclide test. In this test, your doctor will inject a harmless, radioactive substance into your body and then take pictures of your heart. The radioactive substance shows up as it travels through your heart so your doctor can see your blood flowing and how well your heart is working.

    Ask your doctor to talk you through the options and 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 need to undress to your waist and put on a hospital gown that opens at the front. You’ll also need to remove dentures or dental plates if you have them.

    Sedatives are usually given through a fine tube (cannula) into a vein in your arm or the back of your hand. Your doctor or sonographer will monitor your heart rhythm throughout the procedure.

    You’ll need to lie on your left-hand side on the bed. Your doctor or sonographer will spray a local anaesthetic into the back of your throat to numb it, and place the probe in your mouth. They’ll then ask you to swallow so they can pass the probe into your oesophagus. The test isn't painful but it may feel uncomfortable when your doctor or sonographer passes the probe into your oesophagus. You’ll still be able to breathe normally while it’s in your throat.

    The probe 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.

    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 worn off. This can take up to three hours. After that, you can go home when you feel ready but ask a friend or relative to drive you.

    After a local anaesthetic, it can take a while for the feeling to come back into your mouth and throat. Don’t try to eat or drink anything until you can swallow normally. This may take half an hour to an hour. 

    Your doctor or sonographer might be able to talk you through the results of your transoesophageal echocardiogram straightaway. Or they’ll send the results to your doctor who will go through them with you at your next appointment.

  • Recovery Recovering from transoesophageal echocardiogram

    Having a sedative can make you feel sleepy. You might find you’re not as coordinated as usual or that it’s difficult to think clearly. This should pass within 24 hours. In the meantime, don’t drive, drink alcohol, operate machinery or sign anything important.

    You can get back to your usual activities the day after your procedure because the effects of the sedative will have worn off by then.

  • Side-effects Side-effects of transoesophageal echocardiogram

    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 but this isn’t common.

  • Complications Complications of transoesophageal echocardiogram

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

    • damage or a tear to your oesophagus
    • an allergic reaction to the sedative – this can take the form of breathing difficulties or feeling sick
    • inhaling the contents of your stomach – this shouldn’t happen if you stop eating and drinking before the procedure
  • FAQ: Swallowing the probe What if I can’t swallow the probe?

    Swallowing the probe can be a bit uncomfortable but shouldn’t be painful. The probe itself is relatively thin and flexible so that you can swallow it. And your doctor will spray a local anaesthetic into the back of your throat before you have the procedure. This will make it easier to swallow the probe because it will help to stop your gagging reflex. They’ll usually give you a sedative too, which will help you relax.

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

  • FAQ: Which test to have Why has my doctor recommended this test?

    A transoesophageal echocardiogram produces more detailed pictures of your heart than a standard echocardiogram.

    In a standard 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 probe is placed close to the back of your heart.

  • FAQ: Finding heart problems How will my doctor know if there’s a problem?

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

    They’ll look at the shape of your heart valves and how they’re moving, for example, to check for heart valve disease. They’ll also look for signs of calcium deposits, which are the most 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. Your doctor or sonographer will look at the size, thickness and function of your left ventricle to check how well your heart is pumping blood. The left ventricle is one of the lower chambers of your heart. It pumps blood that contains oxygen around your body. Checking the size of your left ventricle and how well it’s working can show if there’s a problem with your heart’s ability to pump blood.

  • FAQ: Results What will happen after I get the results?

    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. A transoesophageal echocardiogram is just one test that doctors use to look at how well your heart is working. Others may include an electrocardiogram (ECG), a chest X-ray, blood and urine tests.

    Your doctor might diagnose a problem with your heart using the results of all these tests. But your transoesophageal echocardiogram may also rule out a problem with your heart or show you need further tests before they can make a diagnosis.

    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 an operation.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • General ultrasound. American College of Radiology. www.radiologyinfo.org, reviewed 30 May 2016
    • Patient information leaflet: trans-oesophageal echocardiography. British Society of Echocardiography. www.bsecho.org, published 22 February 2017
    • What is transesophageal echocardiography? National Heart Lung and Blood Institute. www.nhlbi.nih.gov, updated March 2012
    • Upper GI tract anatomy. Medscape. emedicine.medscape.com, updated 28 June 2016
    • Cardiovascular medicine. Oxford handbook of clinical medicine (online). Oxford Medicine Online. oxfordmedicine.com, published January 2014
    • Wheeler R, Steeds R, Rana B, et al. A minimum dataset for a standard transoesophageal echocardiogram: a guideline protocol from the British Society of Echocardiography. Echo Res Pract 2015; 2(4):G29–45. doi:10.1530/ERP-15-0024
    • Echocardiography. PatientPlus. patient.info/patientplus, last checked 27 November 2015
    • Picard MH, Adams D, Bierig SM, et al. American Society of Echocardiography recommendations for quality echocardiography laboratory operations. J Am Soc Echocardiogr 2011; 24(1):1–10. doi:10.1016/j.echo.2010.11.006
    • Cardiac imaging tests. The MSD Manuals. www.msdmanuals.com, last full review/revision February 2016
    • Cardiac tests. Medscape. emedicine.medscape.com, updated 18 December 2016
    • Radionuclide imaging. The MSD Manuals. www.msdmanuals.com, last full review/revision February 2016
    • Patient information leaflet: exercise stress echocardiography. British Society of Echocardiography. www.bsecho.org, accessed 21 February 2017
    • What to expect during transesophageal echocardiography. National Heart Lung and Blood Institute. www.nhlbi.nih.gov, updated 12 March 2012
    • Echocardiography. The MSD Manuals. www.msdmanuals.com, last full review/revision February 2016
    • What to expect after transesophageal echocardiography. National Heart Lung and Blood Institute. www.nhlbi.nih.gov, updated 1 February 2016
    • What are the risks of transesophageal echocardiography? National Heart Lung and Blood Institute. www.nhlbi.nih.gov, updated 1 February 2016
    • Transesophageal echocardiography (TEE). American Heart Association. www.heart.org, last reviewed July 2015
    • Aortic stenosis. BMJ Best Practice. bestpractice.bmj.com, last updated 22 August 2016
    • Aortic stenosis. Medscape. emedicine.medscape.com, updated 11 December 2016
    • Heart anatomy. Medscape. emedicine.medscape.com, updated 21 July 2015
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  • Author information Author information

    Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, April 2017
    Expert reviewer, Mr Mark Yeatman, Consultant Cardiothoracic Surgeon
    Next review due April 2020

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