Transesophageal Echocardiogram

Why It Is Done

Transesophageal echocardiogram (TEE) may be done to:

• Monitor heart function during surgery.
• Look for masses or blood clots in the upper left chamber (left atrium) of the heart.
• Check how well a replacement heart valve works.
• Measure the speed at which blood travels through the heart.
• Measure the blood pressure and speed of blood flow through the heart valves.
• Identify abnormal blood flow between the chambers of the heart (cardiac shunt).
• Help find out if you have endocarditis, which is an infection of the heart's valves or its inner lining (endocardium).
• Guide procedures done during cardiac catheterization.
• Help find out if you have a tear in the aorta (aortic dissection).

How to Prepare

Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.

Preparing for the procedure

• Follow your doctor's instructions exactly about when to stop eating and drinking before the test. This may be about 8 hours.
• Be sure to tell your doctor about any problems you have with your stomach or esophagus.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what procedure is planned, along with the risks, benefits, and other options.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
• If you take aspirin or some other blood thinner, ask your doctor if you should stop taking it before your procedure. Make sure that you understand exactly what your doctor wants you to do. These medicines increase the risk of bleeding.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don't have one, you may want to prepare one. It lets others know your health care wishes. It's a good thing to have before any type of surgery or procedure.

How It Is Done

Before a TEE, your throat may be numbed with an anesthetic spray, gargle, or lozenge. This is to relax your gag reflex and to make it easier to insert the probe. Shortly before the procedure starts, an IV line will be placed in a vein in your arm. Medicine to decrease saliva and stomach secretions may be given through the IV. A pain medicine and sedative will be given to you through the IV in your arm during the procedure. You should feel relaxed and drowsy but still alert enough to cooperate.

Your heart rate, breathing rate, and blood pressure will be monitored throughout the procedure. Also, a small device used to measure the amount of oxygen in your blood (pulse oximeter) may be attached to your finger or earlobe.

You will be asked to lie on your left side with your head tilted slightly forward. A mouth guard may be inserted to protect your teeth from the probe. Then the lubricated tip of the probe will be guided into your mouth while your doctor gently presses your tongue out of the way. You may be asked to swallow to help move the tube along. It may be helpful to remember that the probe is no thicker than many foods you swallow. When the probe is in your esophagus, it will be moved down gently to the level of your upper right heart chamber (atrium), and ultrasound images will be taken. You won't feel or hear the sound waves during the test.

During the procedure, try not to swallow unless you are asked. An assistant may remove the saliva from your mouth with a suction device. Or you can just let the saliva drain from the side of your mouth. A transesophageal echo is generally painless. But you might feel nauseated and uncomfortable while the probe is in your throat.

How long the test takes

The test may take about 30 to 60 minutes. The probe may be in your esophagus for about 10 to 20 minutes.

How It Feels

• You may notice a brief, sharp pain when the intravenous (IV) needle is placed in a vein in your arm.
• The anesthetic sprayed into your throat may taste bitter. It will make your tongue and throat feel numb and swollen. Some people feel like they can't breathe at times because of the probe in their throat, but this is a false sensation caused by the anesthetic. There is always plenty of breathing space around the probe in your mouth and throat. Remember to relax and take slow, deep breaths.
• You may gag and feel nausea, bloating, or mild belly cramping when the probe is moved. If the discomfort is severe, alert your doctor with an agreed-upon signal or a tap on the arm. Even though you won't be able to talk during the procedure, you can still communicate.
• The IV medicines will make you feel relaxed and drowsy. You will be awake enough to cooperate. You may not be able to remember much of the test.
• Other side effects—such as heavy eyelids, trouble speaking, a dry mouth, or blurred vision—may last for several hours after the test.

After the test, you may have a tickling, dry throat; slight hoarseness; or a mild sore throat. These symptoms may last for 2 to 3 days.

Risks

A transesophageal echocardiogram (TEE) can sometimes cause:

• Nausea.
• Mouth and throat discomfort.
• Minor bleeding.
• Trouble breathing.
• Slow or abnormal heartbeats.

Insertion of the probe may tear or puncture your esophagus. This is rare.

Results

Results are usually available within one day. If the test is done by a cardiologist, the results may be available immediately after the test.

Echocardiogram

Normal:	The heart chambers and walls of the heart are of normal size and thickness, and they move normally.
	Heart valves are working normally, with no leaks or narrowing. There is no sign of infection.
	The amount of blood pumped from the left ventricle with each heartbeat (ejection fraction) is normal.
	There is no excess fluid in the sac surrounding the heart, and the lining around the heart is not thickened.
	There are no tumors and blood clots in the heart chambers.
Abnormal:	Heart chambers are too big. The walls of the heart are thicker or thinner than normal. A thin heart wall may mean poor blood flow to the heart muscle or an old heart attack. A thin, bulging area of the heart wall may indicate a bulge in the ventricle (ventricular aneurysm). The heart muscle walls do not move normally because of a decreased blood supply from narrowed coronary arteries.
	One or more heart valves do not open or close properly (are leaking) or do not look normal. Signs of infection are present.
	The amount of blood pumped from the left ventricle with each heartbeat (ejection fraction) is lower than normal.
	There is fluid around the heart (pericardial effusion). The lining around the heart is too thick.
	A tumor or blood clot may be found in the heart.