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Transoesophageal echocardiogram


Expert reviewer, Mr Mark Yeatman, Consultant Cardiothoracic Surgeon
Next review due April 2020

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

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.

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.

What are the alternatives to 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.

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

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.

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 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 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

Frequently asked questions

  • 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.

  • 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.

  • 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.

  • 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.


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Related information

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  • 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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