Your doctor may recommend a transesophageal echocardiogram, or TEE for short, if it's not possible to get a good image of the heart with a regular echocardiogram that views the heart through the outside of your chest wall.
The reasons for a TEE can include lung disease, obesity, breast implants or very large breasts, structural abnormalities such as closely positioned ribs, or previous chest or heart surgery - all of which can make it difficult to get a good image.
In my case the doctors were unable to get a good look at my aortic valve (despite repeated efforts) because my ribs are very close together.
For the TEE, similar to the regular echocardiogram, you will lie on a bed in a darkened room on your back or left side. Unlike the regular echocardiogram, you will have an IV and your team will include doctors, not just technicians.
You will be sedated and a topical anesthetic will be swabbed or sprayed on the back of your throat, both of which help decrease the gag reflex. Once everyone is ready, an ultrasound transducer will be placed into your esophagus (or food pipe).
Although it's not a particularly pleasant experience, it's not nearly as bad as it sounds!
For one thing, the transducer is much smaller than the one used for a regular echocardiogram. When the transducer is placed in your mouth you will be asked to swallow. It sounds impossible but you will be able to do it.
Once the transducer is in your esophagus, it will be positioned just behind the heart where it's possible to get a clear image with limited obstacles in the way. The advantage of TEE is clearer images, especially of structures that are difficult to view (from outside the chest wall).
Although you are sedated, you will be awake for the procedure. This is important because your doctor may ask you to hold your breath or have other instructions for you to follow.
When I had my first transesophageal echocardiogram, I'll never forget hearing my doctor say, "Well, look at that. It's a bicuspid valve!" Much of my memory of the procedure is quite fuzzy but that statement was crystal clear!
Your heart rate, blood pressure and breathing will be monitored during the procedure. Oxygen may be given. If you require more sedation, they will make the appropriate adjustments through the IV.
Using this test, your doctor will be able to get a better view of the aorta, pulmonary artery, valves of the heart, both atria, atrial septum, left atrial appendage, and coronary arteries.
The actual procedure will take 10 to 30 minutes but you need to plan to be in the clinic for up to two hours. Your doctor will schedule a follow-up meeting to discuss the results - you may be too drowsy from the sedation to fully understand the report right afterwards.
Your doctor or clinic should provide you with instructions. In general
Your doctor will provide you with instructions, but in general
If you experience bleeding, persistent pain or fever, call your doctor. These symptoms are not normal.
Unlike the regular echocardiogram, the transesophageal echocardiogram is an invasive procedure. Some risks are associated with the procedure itself (esophageal perforation--1 in 10,000) and there is the risk of adverse reactions to the sedative. However, it IS a safe procedure that is performed often and the diagnostic opportunities are very beneficial.