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):
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).