Transesophageal Echocardiogram

About the Procedure

A standard echocardiogram or Echo is obtained by applying a transducer to the front of the chest. The ultrasound beam travels through the chest wall (skin, muscle, bone, tissue) and lungs to reach the heart. Because it travels through the front of the chest, or thorax, a standard echocardiogram is also known as a TRANSTHORACIC echo.

Sometimes there are conditions such as closely positioned ribs, obesity and emphysema which may limit the transmission of ultrasound beams to and from the heart. In such cases, your provider may elect to get a transesophageal echo, where the echo transducer is placed in the esophagus or food pipe that connects the mouth to the stomach. Since the esophagus sits behind the heart, the echo beam does not have to travel through the front of the chest, avoiding many of the obstacles described above. In other words, it offers a much clearer image of the heart, particularly the back structures, such as the left atrium, which may not be seen as well by a standard echo taken from the front of the heart.

How the test is performed

  • You will lie on your left side. A sedative will be given through an intravenous (IV) line to help you relax and your throat will be sprayed with an anesthetic to “numb” it. The TEE echo transducer is much smaller than the standard Echo equipment and is positioned at the end of a flexible tube (similar to the tube used to examine the stomach during endoscopy). The tube transfers the images from the transducer to the Echo monitor.
  • You will begin to swallow the tube as the procedure begins. The use of anesthesia and the sedative minimizes your discomfort and there is usually no pain. The tube goes down the esophagus the same way as swallowed food. Therefore, it is important that you swallow the tube rather than gag on it.
  • The transducer at the end of the tube is positioned in the esophagus, directly behind your heart. By rotating and moving the tip of the transducer, the physician can examine the heart from several different angles. Your heart rate, blood pressure and breathing are monitored during the procedure. Oxygen is given as a preventive measure and suction is used as needed.
  • After the procedure, driving is not allowed for 12 hours (because of the use of sedatives). Eating and drinking should be avoided for at least two hours because your throat will still be numb and the food or drink could be aspirated into the lungs. Hot food and drinks should not be used for about 24 hours. Your throat may be sore and throat lozenges can be used after two hours of the procedure. It is unusual to experience bleeding, persistent pain or fever. These should be reported to your doctor immediately.


Preparing for the test:

  • Do not eat or drink for six hours. This will minimize the risk of vomiting and aspirating during the procedure.
  • Medications prescribed by your doctor may be taken with sips of water, if you are not instructed to stop taking them.
  • Arrange for a ride home if the procedure is performed on an outpatient basis.
  • Be sure to notify your doctor or nurse if you have any allergies, or if you have any difficulty in swallowing or problems with your mouth, esophagus or stomach.
  • Dentures should be removed.