Described below is a regular trans-thoracic echocardiogram.
To review two other types of echo, click one one of
the links above:
How does TEE differ from a standard
Echocardiogram?
How is TEE performed?
Preparing for the test?
How long does it take?
How safe is it?
What information is provided by TEE?
How quickly will I get the results?
Show me images from a TEE procedure
How does TEE differ
from a standard ECHO? 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 (pronounced thow-racks)
a standard echocardiogram is also known as a TRANSTHORACIC
(pronounced trans-thow-rassic) echo, as shown below
(left):
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At times, closely positioned ribs, obesity and emphysema
may create technical difficulties by limiting the
transmission of the ultrasound beams to and from the
heart. In such cases, your physician may select to
get a transesophageal (pronounced trans-esoff-a-gee-ul)
echo, where the echo transducer is placed in the esophagus
(pronounced esoff-a-gus) 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. This is shown in the picture
above (right).
How is a a TEE performed?
The patient is made to lie on the left side. A sedative
is given through an intravenous (IV) line to help
in relaxation and the throat is 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.
The patient begins to swallow the tube and the procedure
begins. The use of anesthesia and the sedative minimizes
discomfort and there is usually no pain. The tube
goes down the esophagus the same way as swallowed
food. Therefore, it is important that the patient
swallow the tube rather than gag on it.
The transducer at the end of the tube is positioned
in the esophagus, directly behind the heart. By rotating
and moving the tip of the transducer, the physician
can examine the heart from several different angles.
The 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 the 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.
The 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 the physician.
Preparing for the
TEE:
- 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
hold them.
- Arrange for a drive home if the procedure is performed
on an outpatient basis.
- Be sure to notify the 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.
How long does a TEE procedure
take? You should plan to be in the cardiac
lab for about two hours. The actual procedure usually
lasts 10 to 30 minutes. The remainder of the time
is spent in preparation and observation.
How safe is TEE? TEE is
a relatively common procedure and considered to be
fairly safe. However, it does require entrance into
your esophagus and stomach. On occasions, patients
may experience breathing problems, abnormal or slow
heart rhythm, reaction to the sedative and minor bleeding.
In extremely rare cases TEE may cause perforation
or tear of the esophagus.
How soon will I get
the results? The physician can usually provide
the results immediately after the procedure. However,
the doctor may prefer to review the tape again before
giving a final report. Also, if the patient appear
drowsy from the sedative, a conference may be set
up for a later time.
What Information is provided
by TEE? A TEE is extremely useful in detecting
blood clots, masses and tumors that are located inside
the heart. It can also gauge the severity of certain
valve problems and help detect infection of heart
valves, certain congenital heart diseases (like a
hole between the upper chambers of the heart, known
as an ASD or atrial septal defect) and a tear (dissection)
of the aorta (major artery of the body). TEE is also
very useful in evaluating patients who have had mini
or major stokes as a result of blood clots. The procedure
may detect the responsible clot inside the left atrium.
The pictures
displayed on the monitor (above) were taken during
a TEE procedure in a patient with a heart tumor (known
as a left atrial myxoma, pronounced mix-o-ma). The
video on the left shows the large round tumor (marked
by the arrow) "bouncing" around in the left
atrium (left upper chamber of the heart, which actually
sits immediately in front of the esophagus). TEE was
performed during surgery. The video on the right shows
that the tumor has been completely removed (the arrow
points to an "empty" or tumor-free chamber).
