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Transesophageal echocardiogram

What a transesophageal echocardiogram (or TEE) is and when this type of heart ultrasound is needed.

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.

How is it done?

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.

How do I prepare for a transesophageal echocardiogram?

Your doctor or clinic should provide you with instructions. In general

  • Do not eat or drink for six hours prior. This will minimize the risk of vomiting or choking during the procedure.
  • Prescribed medications should be taken on your regular schedule with a small amount of water - unless your doctor tells you differently.
  • Arrange for a drive home if the procedure is being performed on an outpatient basis.
  • Tell your doctor or nurse if you have allergies, if you have difficulty swallowing, or problems with your mouth, esophagus, or stomach.
  • If you wear dentures, they should be removed.

What about after the procedure?

Your doctor will provide you with instructions, but in general

  • Driving is not allowed for 24 hours (due to the sedatives). You will need someone to take you home.
  • Avoid eating and drinking (especially hot foods or drinks) for at least two hours because your throat will still be numb and the food or drink could be aspirated into your lungs.
  • You may experience a sore throat. You can take throat lozenges two hours after the the procedure.

If you experience bleeding, persistent pain or fever, call your doctor. These symptoms are not normal.

What are the risks?

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.

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