Understand What is Transesophageal Echocardiogram

A transesophageal echocardiogram (TEE) is a diagnostic test that uses sound waves to capture detailed heart images. Unlike traditional echocardiograms or ultrasounds, which take pictures from outside the body, a TEE obtains images from within. This is achieved by guiding a thin, flexible tube called an endoscope down the throat and into the esophagus. At the tip of this tube is a small transducer, which emits sound waves that bounce off the heart's structures, producing echoes.

‍

These echoes are then transmitted to a computer and converted into clear, detailed images. During the procedure, the transducer creates high-quality pictures revealing the heart’s structure and functioning. The proximity of the esophagus to the heart allows for a more detailed and precise examination, especially in cases where other imaging methods might not provide sufficient information.

‍

TEE is often used to detect heart valve problems, blood clots, or congenital heart defects. Sometimes, TEE may be combined with Doppler ultrasound and color Dopcolorechniques. These advanced methods allow blood flow visualization, showing its speed and direction through the heart. This comprehensive approach helps doctors diagnose and monitor heart conditions more accurately.

‍

Why is a Transesophageal Echocardiogram Performed?

Doctors use a transesophageal echocardiogram (TEE) to diagnose heart structure and function issues. Compared to standard echocardiograms, TEE provides more explicit images of the ascending aorta, the upper chambers of the heart, and the valves between the heart’s chambers.

‍

Transesophageal echocardiogram (TEE) is commonly used during surgeries to repair heart valves, aortic tears, or congenital heart defects. It’s also valuable in surgeries for endocarditis, a bacterial infection that affects the heart’s inner lining and valves, and offers critical information for treatment.

‍

The detailed images provided by a transesophageal echocardiogram (TEE) can help your healthcare team evaluate:

• The size of your heart and the thickness of its walls.

• How well your heart is pumping.

• Abnormal tissue around your heart valves could indicate bacterial, viral, or fungal infections or cancer.

• Defects that may cause heart murmurs.

• If blood is leaking backwardsbackwardyour heart valves (regurgitation) or if your valves are stiff, narrowed, or blocked (stenosis).

• Blood clots in the heart's chambers, particularly the upper chamber, are seen in conditions like atrial fibrillation.

‍

Diagnosis and Management of Heart Conditions

If a transthoracic echocardiogram (TTE) doesn’t provide enough detail, your provider may recommend a transesophageal echocardiogram (TEE). Unlike a TTE, performed outside the body, a TEE allows for a closer view by bypassing the ribs and lungs.

‍

The esophagus behind the heart is the ideal spot for sending and receiving sound waves, making TEE especially useful for examining structures at the back of the heart.

‍

It allows the examination of your

• Left atrium: The upper left chamber of your heart.

• Left atrial appendage (LAA): The small, ear-shaped pouch in the left atrium where blood clots can form.

• Interatrial septum: The wall that divides the left and right atria.

• Thoracic aorta: The portion of the aorta that runs through your chest.

‍

In some cases, providers may opt for TEE over TTE initially, particularly if you have:

• Chest anatomy that makes a transthoracic echo challenging.

• Lung disorders.

‍

In Emergency and Critical Care conditions

TEE is used to investigate life-threatening medical conditions, often without a prior transthoracic echocardiogram (TTE) in critical situations. This may occur if you have unexplained hemodynamic instability, hypotension, or hypoxia.

‍

TEE can also be used initially to diagnose urgent issues such as aortic dissection, heart attack, prosthetic valve complications (e.g., blood clots or infections), or chest trauma. In these cases, TEE provides a more detailed and immediate assessment.

‍

TEE may be used initially, without a prior TTE, in critical situations like:

• Hemodynamic instability (problems with blood pressure and blood flow)

• Hypotension (low blood pressure)

• Hypoxia (low oxygen)

‍

It may also be used to investigate urgent conditions such as:

• Aortic dissection or other sudden aorta issues requiring immediate attention

• Heart attack

• Prosthetic valve problems (e.g., blood clot or infection)

• Chest trauma

‍

Checking of blood clots before any procedure

Providers use TEE to check for blood clots before procedures that treat arrhythmias, such as catheter ablation and electrical cardioversion. These procedures carry the risk of causing a blood clot to break free, potentially traveling the bloodstream and causing serious complications like thromboembolism.

‍

Your provider will inform you if TEE is necessary to ensure your safety and reduce the risk of clot-related complications before undergoing these treatments.

‍

To aid surgical procedures

TEE is a valuable tool during various surgeries and procedures. Your provider may use it before surgery to assess your anatomy and the procedure's success afterward. TEE is commonly used for surgeries like congenital heart disease repair, valve repair, and valve replacement.

‍

It also plays a key role in guiding real-time, percutaneous procedures, such as Transcatheter Aortic Valve Replacement (TAVR), Transcatheter Mitral Valve Repair, Transcatheter Tricuspid Valve Repair, and Transcatheter Left Atrial Appendage closure.

‍

In short, it can be used for:

• Surgery for congenital heart disease

• Valve repair

• Valve replacement

• Transcatheter aortic valve replacement (TAVR)

• Transcatheter mitral valve repair

• Transcatheter tricuspid valve repair

• Transcatheter left atrial appendage.

‍

What Are the Results of Transesophageal Echocardiography?

A transesophageal echocardiogram (TEE) provides a detailed view of your heart's structure and function, helping doctors diagnose various conditions. It offers more explicit images of areas that other imaging techniques may miss, allowing for more accurate heart health evaluations.

‍

TEE can detect several issues, including aortic aneurysms, blood clots, cardiac tumors, tumors, heart defects, and heart valve disease. It is also used to assess infective endocarditis, pericardial disease, and problems with prosthetic valves, offering critical information for treatment and management.

‍

The results can be:

• Aortic aneurysm: A bulge in the largest blood vessel, the aorta.

• Blood clots in the heart: Increased risk of clots in the atria, especially for those with atrial fibrillation.

• Cardiac tumors: The heart may be either cancerous or noncancerous.

• Congenital heart disease: A variety of heart conditions present from birth.

• Heart valve disease includes issues like valve narrowing (stenosis) or leakage (regurgitation) and problems with prosthetic valves, such as infections or growths.

• Infective endocarditis: Infections affecting the heart's tissue or valves.

• Pericardial disease: Disorders involving the sac surrounding the heart.

‍

How to Prepare for a Transesophageal Echocardiography?

Your provider will give you specific instructions on how to prepare for a transesophageal echocardiogram (TEE). Typically, you’ll need to fast for 6 to 8 hours before the procedure to ensure your stomach is empty, which helps provide a clear view of your heart. It’s essential to avoid alcohol for at least 24 hours before the transesophageal echocardiogram (TEE).

‍

Alcohol can interfere with the sedative effects and may affect the accuracy of the procedure. Be sure to inform your provider about any health conditions, habitual disorders, or medications, as adjustments may be needed before the procedure.

‍

Inform your provider if you have:

• Esophageal cancer

• Gastritis

• GERD (chronic acid reflux)

• Hiatal hernia

• IV drug use

• Problems swallowing

• Sleep apnea

• Stomach cancer

‍

Also, let your provider know if you take medication for:

• Sleep issues

• Anxiety

• Pain

‍

What Happens During the Process of Transesophageal Echocardiography?

During a transesophageal echocardiogram (TEE), a specially trained technician, called a sonographer, performs the procedure. The technician guides a thin tube with a small ultrasound device (transducer) down your throat to capture detailed images of your heart. Your heart doctor (cardiologist) will then review the results.

‍

Patients shouldn’t worry about the procedure being painful. Though the tube is inserted through the throat, most people feel only mild discomfort. Sedation is provided to ensure relaxation and comfort throughout the process.

‍

The following steps are generally followed:

• The technician sprays your throat with a numbing medicine to reduce discomfort and suppress the gag reflex. 

• You’ll be lying on a table.

• A nurse inserts an IV (intravenous line) in your arm and administers medicine to help you stay calm.

• The technician places small pads (electrodes) on your chest, connected to a machine that records your electrocardiogram (ECG) and monitors your heartbeat.

• A thin, flexible tube (probe) is gently guided through your mouth and throat. You must swallow as it moves.

• A transducer at the end of the probe sends sound waves to your heart, collecting the echoes to create images displayed on a video screen.

• Once the TEE is complete, the probe, IV, and electrodes are removed, and you will be monitored until you are fully awake. 

• Afterward, you can dress and be discharged from the clinic or hospital.

‍

What Happens After TEE?

After a TEE, your throat may be numb for a short time. It’s important not to eat or drink anything until the numbness fades to avoid the risk of choking. You may also experience some difficulty swallowing immediately after the test, but this should improve within a few hours. 

‍

A sore throat for a day or two is common following the procedure. Since a sedative is used during the test, it's recommended that someone else drive you home afterward. You should be able to resume driving 24 hours later.

‍

What Are the Risks of Transesophageal Echocardiogram?

The risks of a transesophageal echocardiogram (TEE) are mainly related to the insertion of the probe through your mouth, throat, and esophagus. Although you will be given medication to relax and numb your throat, you may still experience a sensation of gagging during the procedure.

‍

Afterward, it’s common to have a sore throat for a day or two. In rare cases, some people may experience an allergic reaction to the medications or minor bleeding in the esophagus. If severe complications are noticed, you must consult your physician.

‍

Other less common complications may include:

• Allergic reactions to medications

• Aspiration pneumonia

• Blood pressure or heart rhythm issues

• Minor bleeding in the esophagus

‍

Does TEE Require Sedation?

A TEE is considered invasive since the provider must insert a device into your body. While mild discomfort is possible, the risk of serious complications is low. Typically, a TEE only requires local anesthesia and moderate sedation.

‍

Your provider will numb the back of your throat with pain-relieving medication and administer a relaxing sedative through an IV. Most patients do not need general anesthesia (deep sleep), but you must discuss with your provider what option is best for you during the procedure.

‍

Conclusion

A transesophageal echocardiogram (TEE) provides invaluable insights into heart function, particularly in cases where a standard echocardiogram is insufficient. Its high-resolution imaging allows for detailed assessment of the heart's structures, valves, and blood flow. For patients seeking accurate analysis of their TEE reports, Gauze offers a reliable platform to interpret and assess echo results.

‍

Utilizing advanced algorithms and expert insights, it ensures comprehensive and precise evaluations, empowering healthcare providers and patients with actionable information for optimal heart health management.