Transesophageal echocardiogram vs Echocardiogram

With changing lifestyles, heart diseases have become widespread worldwide. While echocardiography services are also readily available in urban areas, they are improving in rural areas due to the adoption of telemedicine and mobile diagnostic facilities. Whenever it is necessary to investigate the heart's condition, an echocardiogram is required. The most common type of echocardiogram (echo) is a transthoracic echocardiogram (TTE). A transesophageal echocardiogram provides a clear view of structures such as the left atrium, mitral valve, and thoracic aorta.

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In this article, we will examine the differences between a standard echocardiogram (TTE) and a transesophageal echocardiogram, including their respective indications and applications.

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What is an echocardiogram?

Echocardiogram and transesophageal echocardiogram use high-frequency sound waves to obtain images of the heart.

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Both use the principle of the piezoelectric effect. A crystal made of piezoelectric material, lead zirconate titanate, placed in the transducer converts electrical energy into sound waves and vice versa. The ultrasound transducer emits and receives ultrasound waves. The echoes from the heart create images of the heart's structure and function.

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Transesophageal echocardiogram vs echocardiogram

Let us evaluate the differences between the two.

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Procedure

TEE: A flexible tube with a small ultrasound device at the tip is gently inserted into the esophagus through the mouth. The patient is sedated, and once in place, the sound waves travel through the body tissues to the heart tissue, where they bounce off the heart's structure. The reflected waves are picked up by the transducer and sent to the computer. The computer displays these as images of the heart walls, valves, and circulation.

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TTE: A transducer is moved over the patient's chest, sending and receiving high-frequency waves to create images of the heart's structures. The sonographer takes images of the heart from various angles, such as the long axis, short axis, apical region, and subcostal region.

Invasiveness

TEE is a minimally invasive procedure that requires sedation when the transducer is inserted into the esophagus.

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TTE is a safe and noninvasive procedure that does not require anesthesia.

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Image quality

TEE: Provides a clear image of the heart as the sound waves do not have to pass through the skin, muscles, or bone tissue. The transesophageal probe is positioned near the heart when inserted into the esophagus. It provides clear images of the back of the heart in patients with a history of previous surgeries and obesity. It helps to diagnose conditions such as mitral valve disorders, blood clots, or masses inside the heart. The structure and function of artificial heart valves are better observed with TEE.

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TTE: It serves as a comprehensive diagnostic and management tool for heart conditions. It helps to capture dynamic images of the heart.

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Indications

TTE: It is the first-line test used when detailed images of the heart are required. It is used to evaluate

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• Diagnosing heart conditions
  
  • Evaluating heart structure, size, and shape, the thickness of walls, and the condition of valves
  • Assessing heart function, which is how well the heart is pumping
  • the amount of blood ejected with each heartbeat, and the efficiency of the blood
  • flow.
  • Identifying valvular defects, such as backflow (Regurgitation) or narrowing (stenosis) of the valve.
  • Detecting congenital abnormalities

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• Monitoring heart health
  
  • TTE tracks the progress of the disease and the effectiveness of the treatment being given.
  • It assesses the risk potential of individuals with metabolic diseases or lifestyle diseases, such as diabetes or hypertension. 
  • It helps a doctor by providing information about the structure and function of the heart to decide upon the prognosis of the disease.

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TEE: It is usually advised when the images produced by the transthoracic echocardiogram are not clear, or in cases where the patient is obese, has pulmonary disease, or has had previous surgery. It helps in diagnosing.

• Atherosclerosis
• Cardiomyopathy
• Congenital heart disease
• Heart failure
• Aneurysm
• Heart valve disease
• Cardiac tumour
• Aortic dissection
• Pericarditis
• Infective endocarditis
• Blood clots and strokes.

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It also helps in evaluating the heart.

• 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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Advantages/Disadvantages

TEE and TTE are safe tests, as they use sound waves rather than ionizing radiation, unlike X-rays, CT scans, and MRIs.

TEE has the advantage over TTE in that it provides clearer images.

TEE requires anesthesia and is a minimally invasive procedure.

TTE may not provide clear images, so that TEE may be necessary.

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Risks and Safety

TEE has minor risks, such as causing a sore throat after the probe is removed from the esophagus. Other risks are minor injuries and bleeding from the esophagus.

TTE is a safe and superficial procedure.

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Conclusion

Both transthoracic echocardiograms (TTEs) and transesophageal echocardiograms (TEEs) are valuable tools for assessing the structure and function. TTE is a simple and painless test, which is why it is usually the first one performed. TEE is an invasive procedure that provides clearer, more detailed images when TTE is insufficient. The two procedures have specific purposes, and based on your symptoms, your doctor is best positioned to recommend the most suitable test for you. At Gauze, we support you in deciding what is best needed for your patient.