Transoesophageal echocardiogram

Your health expert: Dr Mary Lynch, Consultant Cardiologist
Content editor review by Pippa Coulter, March 2022
Next review due March 2025

A transoesophageal echocardiogram is an ultrasound test that produces detailed, moving, real-time pictures of your heart. It involves passing an ultrasound probe down your oesophagus (your food pipe) to take images of your heart from inside your body.

About transoesophageal echocardiogram

A transoesophageal echocardiogram shows your doctor the structure of your heart and how well it’s working. It gives more detailed pictures than a standard transthoracic echocardiogram.

A transthoracic echocardiogram uses an ultrasound probe placed over your chest to take images of your heart. A transoesophageal echocardiogram takes images from inside your oesophagus. This is the tube that goes from your mouth to your stomach, and it’s right behind your heart. This means the images will be much clearer than those from a transthoracic echocardiogram.

Why have a transoesophageal echocardiogram?

A transoesophageal echocardiogram can check any of the structures in your heart. Your doctor may recommend one if you’ve already had a standard echocardiogram and they need more detailed pictures. Sometimes, you may have a transoesophageal echocardiogram first, if you can’t have a standard one for some reason.

A transoesophageal echocardiogram can check for lots of different things to do with your heart. For example, 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 of your heart affected by a heart attack
  • infection in your heart (endocarditis)

A surgeon can also use it to monitor you when you’re having an operation on your heart.

Preparation 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. The hospital will give you information explaining how to prepare for your procedure. They’ll usually ask you not to eat or drink anything for about six hours beforehand. It’s usually fine to take any regular medication on the morning of your appointment with a sip of water. But follow any advice you’re given.

The hospital staff will want to know if you’re taking any medicines that help to prevent your blood clotting – for example, warfarin. If they haven’t asked before you have your test, be sure to tell them. You should also let your doctor know if you have any problems with swallowing because this may mean you need an alternative procedure.

You usually have the procedure under local anaesthesia. This means you’ll be awake during the procedure. But you may also have a sedative, which will help you to relax and may make you feel a bit sleepy. If you have a sedative, you will need someone who can drive you home and stay with you overnight.

At the hospital, your doctor will explain exactly what to expect during a transoesophageal echocardiogram, including the risks and benefits. Make sure you talk to your doctor if you have any questions or concerns. You’ll be asked to sign a consent form before the procedure goes ahead, so it’s important to make sure you feel fully informed.

Transoesophageal echocardiogram procedure

A transoesophageal echocardiogram usually takes about 20 to 30 minutes. A doctor or a sonographer (a technician trained to use ultrasound) may do the procedure.

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. The doctor or sonographer will place ECG (electrocardiogram) stickers on your chest so they can monitor your heart throughout the test. 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. They’ll 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. These are converted into pictures of the inside of your heart. The images are displayed on a monitor in real time, so the scan shows your heart as it’s beating.

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

Aftercare for transoesophageal echocardiogram procedure

You’ll be monitored for a short time after your procedure while you recover. If you’ve had a sedative, you’ll need to rest until the effects have worn off. This may take up to three hours. It can take a while for the local anaesthetic to wear off and 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.

Once you’re fully recovered, you’ll be able to go home. You’ll need to have someone who can drive you because it can take up to 24 hours for the effects of a sedative to wear off. Your doctor or sonographer might be able to talk you through the results of your transoesophageal echocardiogram before you go. Or they might send the results to the doctor who requested your test. Once you have your results, your doctor will talk to you about what happens next. They might advise further tests. If your transoesophageal echocardiogram shows up a problem with your heart, they’ll discuss your treatment options with you.

You might feel a bit unsteady after having a sedative. You may also find it hard to think clearly. This should pass within 24 hours. In the meantime, don’t drive, drink alcohol, operate machinery or make any important decisions.

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 bruise or 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 include:

  • problems relating to the sedative, including breathing difficulties or, more rarely, an allergic reaction
  • 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

Alternatives to transoesophageal echocardiogram

There are other types of heart scan that you may be able to have instead of a transoesophageal echocardiogram. These include the following.

  • Cardiac MRI (magnetic resonance imaging) scan. MRI uses powerful magnets, radio waves and computers to produce detailed images of the inside of your heart.
  • Cardiac CT (computed tomography) scan. CT scans use X-rays to create a three-dimensional image of your heart.

Which test your doctor recommends depends on what problem they are investigating. Ask your doctor to explain your options and which procedure is most suitable for you.

A transoesophageal echocardiogram is a type of test for your heart. It helps your doctor to see the structure of your heart and how well it’s working. Your doctor may use it to check for different problems in your heart. They can also use it to monitor you during a heart operation. Find out more in our section, About transoesophageal echocardiogram.

You will usually be awake during a transoesophageal echocardiogram. You’ll have a local anaesthetic to numb your throat, but it won’t make you go to sleep. You may also have a sedative. This can make you feel relaxed and sleepy. For more information, read our Preparation section.

A transoesophageal echocardiogram involves having an ultrasound probe passed down your throat. This takes images of your heart from inside your body. It can feel a bit uncomfortable swallowing the probe but it shouldn’t be painful because your throat will be numb. You can read more on what to expect in our Procedure section.

A doctor or a sonographer can perform a transoesophageal echocardiogram. A sonographer is a technician who has been specially trained in carrying out procedures with ultrasound.

In a standard transthoracic echocardiogram, your doctor or sonographer moves an ultrasound probe over your chest to take the scan. In a transoesophageal echocardiogram, the probe is placed down your oesophagus, which is close to the back of your heart. This means that the pictures are clearer than those of a transthoracic echocardiogram. This enables your doctor to diagnose certain problems with greater accuracy.

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