Transoesophageal echocardiogram

Expert reviewer, Mary Lynch, Consultant Cardiologist
Next review due October 2022

A transoesophageal echocardiogram is an ultrasound test that uses sound waves to produce moving, real-time pictures of your heart. An ultrasound probe is passed down your oesophagus (the tube that goes from your mouth to your stomach) to take the images from inside your body. It gives more detailed pictures of your heart than a standard transthoracic echocardiogram. A transthoracic echocardiogram is an external ultrasound test that produces pictures of your heart by placing an ultrasound probe over your chest.

Man smiling at a doctor

What is a transoesophageal echocardiogram?

A transoesophageal echocardiogram shows your doctor the structure of your heart and how well it’s working. Your doctor uses an ultrasound probe, which is put down your throat so that it’s very near your heart. The ultrasound pictures are then shown on a screen.

This test can check for lots of different things to do with your heart. It can show:

  • problems with your heart valves
  • blood clots within your heart
  • problems with your aorta (the main artery that carries blood away from your heart)
  • areas where heart muscle isn’t working properly because of a heart attack
  • any build-up of fluid around your heart

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.

What are the alternatives to transoesophageal echocardiogram?

Alternatives to a transoesophageal echocardiogram may include the following.

  • Transthoracic echocardiogram (TTE). This produces less detailed images than a transoesophageal echocardiogram. TTE involves a doctor or sonographer moving an ultrasound probe over your chest to get pictures of your heart. You may have this procedure if you would have difficulty swallowing the probe for 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. CT scans use X-rays to create a three-dimensional image of your heart.

Ask your doctor to talk you through the options and which procedure is most suitable for you.

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 will be asked not to eat or drink anything for about six hours beforehand. 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 do 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. If they haven’t asked, make sure to tell them.

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 will 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 the procedure, so if you have any questions, ask your doctor. If you’re not sure you want to have the transoesophageal echocardiogram, you can take more time to decide.

What happens during transoesophageal echocardiogram

A transoesophageal echocardiogram usually takes about 20 minutes.

You’ll need to undress and put on a hospital gown. You’ll also need to remove dentures or dental plates if you have them. You will have ECG stickers put on your chest so the doctor can monitor your heart throughout the test.

If you’re having a sedative, you’ll have a fine tube (called a cannula) put into a vein in your arm or the back of your hand.

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

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 that you may have after a 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:

  • an allergic reaction to the sedative – such as breathing difficulties or feeling sick
  • inhaling the contents of your stomach – this shouldn’t happen if you stop eating and drinking before the procedure
  • a very small risk of damage or a tear to your oesophagus

Frequently asked questions

  • It’s entirely understandable to be concerned when your doctor suggests a test where you will have an ultrasound probe put down your throat. But it’s very unlikely that you won’t be able to manage.

    Swallowing the probe can be uncomfortable but shouldn’t be painful. The probe itself is flexible so that you can swallow it. 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.

    Talk about your concerns with your doctor or sonographer before the test. Tell them if you’ve had previous problems with your throat or neck, any difficulty swallowing or if you’ve ever coughed up blood. They might suggest you have an alternative test.

  • 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.

    In a routine transthoracic echocardiogram, your doctor or sonographer will move an ultrasound probe 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. In a transoesophageal echocardiogram, the probe is placed down your oesophagus and is close to the back of your heart. This means that the pictures are more clear than those of a transthoracic echocardiogram.

    You may have a transoesophageal echocardiogram as a first test – for example, if your doctor wants to find the source of blood clots within your heart. Or if they suspect an infection or want to look at your heart valves.

    Alternatively, you may have a transoesophageal echocardiogram after a standard transthoracic echocardiogram so that your doctor can get more information to help diagnose your condition.

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

    To look for heart valve disease, your doctor can check if the valves are leaking, narrowed or blocked. A transoesophageal echocardiogram can also show if there is an infection in the heart valves. It can show how well your heart is pumping blood, and if there is any abnormality in its size or the thickness of its walls. It may also show up blood clots inside the heart, for example after a stroke.

    During surgery, a transoesophageal echocardiogram can provide the surgeon with important information. For example, it can help when repairing damage or congenital abnormalities (problems that you’re born with) inside the heart such as hole in the heart.

  • 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.

    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), blood tests and CT scan or MRI scan.

    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 Michelle Harrison, Specialist Health Editor, Bupa Health Content Team, October 2019
    Expert reviewer, Mary Lynch, Consultant Cardiologist
    Next review due October 2022