Transesophageal Echocardiogram

A transesophageal echocardiogram (TEE) is a heart ultrasound that uses high-frequency sound waves to create detailed images of the heart. A  standard TTE is done by placing a probe on the chest. Transesophageal echocardiography (TEE) uses a thin, flexible probe inserted down the esophagus, a thin tube that connects the throat to the stomach.

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Since the oesophagus lies just behind the heart, this approach provides clearer images, especially in individuals whose chest structure or medical condition may limit the view from a standard echocardiography, such as transesophageal echocardiography (TEE).

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This approach is especially useful for detecting blood clots, infections, and problems with heart valves. In this blog, we’ll explore what TEE is when it is used, how it is performed, and what to expect before and after the procedure.

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What is a Transesophageal Echocardiogram?

During the procedure, a flexible tube with a small ultrasound device at the tip is gently guided down the throat into the esophagus. The patient is usually sedated for comfort. Once in place, the sound waves move through the body tissues to the heart tissues, where the waves bounce or echo off the heart structure. The transducer picks up the reflected waves and sends them to the computer. The computer displays these as images of heart walls, valves, and the circulation.

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The detailed review is helpful when TTE images are unclear or when doctors need to look for small blood clots, infections, or abnormalities in the heart valves or heart walls. It provides a clear image of the heart because the sound waves do not have to pass through the skin, muscles, or bone tissue. The transesophageal probe is near the heart when in the oesophagus.

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Obesity and lung diseases interfere with images of the heart when the transducer is placed on the chest wall. Conditions such as mitral valve disorders, blood clots, or masses inside the heart, a tear of the lining of the aorta, and the structure and function of artificial heart walls are better observed with TEE.

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Indications of Transesophageal Echocardiogram:-

TEE is done to evaluate the following signs and symptoms that suggest:-

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• Atherosclerosis occurs when the arteries become clogged with fatty material and other substances in the blood.

• Cardiomyopathy: enlargement of the heart due to thickened or weakened heart muscles.

• Congenital heart disease: Diseases that occur during the formation of the foetal heart. TEE helps assess and locate abnormalities and determine their impact on blood flow.

• Heart failure occurs when muscles become weak to the extent that they can’t pump efficiently, causing fluid buildup in the blood vessels, lungs, feet, ankles, and other body parts.

• Aneurysm occurs when the heart muscles or the aorta (a large artery that supplies blood to the body) weaken and bulge.

• Heart valve disease occurs when the heart valves fail to block the blood flow within the heart or result in blood leaking backwards (regurgitation).

• A cardiac tumour is a growth of mass that occurs on the outer surface of the heart within one or more chambers or the muscle tissue of the heart.

• Aortic dissection is a tear in the wall of the aorta.

• Pericarditis: inflammation or infection of the sac around the heart.

• Infective endocarditis is an infection of the heart affecting the valves.

• Blood clots and strokes occur when blood clots from the heart chambers break off, flowing into the brain, causing a stroke.

• Post surgery: To evaluate the heart during open heart surgery, coronary bypass, or valve replacement.

• For evaluating the heart during non-cardiac surgery.

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Benefits of Transesophageal Echocardiogram

• TEE is recommended when a standard echocardiogram taken from the front of the chest does not provide complete information about the structure and function of the heart.

• It provides better quality and clarity of ultrasound images than traditional echocardiography methods.

• It is an advisable method for obese individuals and those with lung disease.

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Risks Associated with Transesophageal Echocardiography

All medical tests carry some risk, and TEE is no exception. The greatest risk is due to the underlying heart disease; however, the risk associated with the procedure itself is small. The procedure is done under sedation, but one can still feel gagging.

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• A sore throat or hoarse voice can develop for a day or two after the test.

• Minor bleeding can occur in the esophagus.

• There is a risk of chest infection.

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Some rare complications are:

• Damage to teeth.

• Damage or tearing of the oesophagus.

• Allergic reaction to the sedative.

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Preparing for a Transesophageal Echocardiogram

The procedure takes almost 20- 30 minutes after all preparations are done:

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• You will be asked to sign a consent form to permit  the test to be done on you.

• You need to fast for a few hours or overnight, about which the health care provider will inform you.

• Inform the doctor about your pregnancy report (if applicable).

• You need to inform the healthcare provider if you are sensitive to medicines, local anaesthetics, or latex.

• All medicines, prescription or over-the-counter, and herbal supplements you are taking should be reported to your health care provider.

• History of bleeding disorders or any anticoagulant or blood thinning medicines like aspirin or others that you are taking should be conveyed to the health care provider. You may be required to stop  these medicines before the procedure.

• Bleeding time and clotting time are the usual blood tests that are done before the procedure; other tests may also be needed.

• The medical history of heart valve disease, including congenital heart conditions or a history of endocarditis (infection of heart valves), should be reported to the healthcare provider.

• Based on your medical condition, you may be advised to make specific preparations.

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During a transesophageal echocardiogram

• Remove any jewellery or metal objects that may interfere with the procedure. All dental prostheses and dentures also need to be removed before the insertion of the probe.

• You may be asked to wear a hospital gown.

• You will be asked to empty your bladder before the procedure.

• An intravenous line will be started in your arm to inject medicines or give IV fluids.

• You’ll be asked to lie on your left side, and a pillow or wedge may be placed behind your back for support.

• Electrodes will be placed on your chest, and you will be connected to the ECG monitor to record the electrical activity of your heart during the procedure.

• There’ll be continuous monitoring of all vital signs like heart rate, blood pressure, breathing rate, and oxygen levels.

• A local anaesthetic spray will be applied to the back of the throat to numb the area, making the insertion of the probe more comfortable.

• You may be sedated before the procedure to help you relax.

• If required, oxygen may be given through the nasal tubes.

• Usually, the rooms where the echocardiography is being done are dark so that the doctor can see images on the monitor.

• As the probe for the echocardiogram is passed through your mouth into the esophagus, you may be asked to swallow the probe.

• When in the right place, the probe will take images, after which it can be removed from the throat.

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 After the transesophageal echocardiogram

• You will be transferred to the recovery area, where your vital signs will be continuously monitored.

• Once the gag reflex returns and vitals are stable, ECG, oxygen, and IV line will all be removed.

• You will feel normal a day after the procedure, and the sore throat may take some time to heal.

• If the TEE procedure is done on an outpatient basis, you will be discharged soon, but will not be able to drive home alone.

• No special care is usually required following the procedure; however, healthcare providers often instruct patients on a case-by-case basis.

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What are the Differences Between a Transthoracic Echocardiogram and a Transesophageal Echocardiogram?

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Alternatives to the Transesophageal Echocardiogram

Alternatives that can be used instead of TEE are:

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• Cardiac MRI (magnetic resonance imaging) scan. MRI uses magnets, radio waves, and computers to produce images of the heart.

• A cardiac CT (computed tomography) scan uses X-rays to create three-dimensional images of the heart.

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Conclusion

A transesophageal echocardiogram is a minimally invasive test that enables us to assess heart function. It provides clear images for detailed evaluation of the heart's structure, valves, and blood flow.

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For patients seeking TEE, Gauze provides support and services to interpret and assess echo results using AI-powered algorithms and expert insights. It provides a thorough evaluation and empowers health care providers and patients with information for heart health management.