Transesophageal Echocardiography

What is transesophageal echocardiography?

Transesophageal echocardiography, or TEE, is an ultrasound study of the heart taken from inside the esophagus. The esophagus is the swallowing tube that runs directly behind the heart. A slim flexible probe carries an ultrasound sensor on its tip. Your throat is numbed and sedation is given. The probe then passes through the mouth and into the esophagus. Only a thin wall separates the probe from the heart, so the pictures are far sharper than those taken through the chest wall. Ribs, lung tissue, and body habitus no longer get in the way. TEE is the preferred test when doctors need fine detail. Examples include looking for a blood clot in the upper chamber, checking an artificial valve, or searching for infection on a valve. It is a diagnostic study, not a treatment. It is also used to guide certain heart procedures in real time.

The study is done with continuous monitoring of your heart rhythm, blood pressure, and oxygen level.

Why Dr. Nanavati may recommend this

A standard echocardiogram is taken through the chest wall, and it answers most questions. TEE is reserved for situations where a clearer view changes decisions.

Common reasons include:

• Looking for a blood clot in the left atrial appendage before restoring rhythm in atrial fibrillation.
• Investigating a stroke of unknown cause, including a possible hole between the upper chambers.
• Suspected infection on a heart valve, known as endocarditis.
• Assessing a leaking or narrowed valve in detail, or checking a replacement valve.
• Evaluating a heart murmur when chest wall images are not clear enough.
• Guiding structural procedures such as left atrial appendage closure.
• Suspected tear in the aorta, the body's main artery.

The American Heart Association explains the valve conditions this test evaluates most often.

How to prepare

• Do not eat or drink for at least six hours before the test, and follow the exact fasting time you are given. An empty stomach is a safety requirement, not a formality.
• Ask which morning medicines to take with a small sip of water. Diabetes medicines and blood thinners need specific instructions.
• Tell the team about swallowing difficulty, hiatal hernia, or reflux. Also mention prior esophageal surgery, radiation to the chest, or any history of esophageal narrowing.
• Report allergies to latex, anesthetic sprays, and sedatives, and any past reaction to sedation.
• Remove dentures, partial plates, and oral piercings before the study.
• Arrange a driver. You cannot drive for the rest of the day after sedation.
• Allow about two to three hours in total, though the imaging itself is much shorter.

What happens during the procedure

An intravenous line is placed, and monitoring pads are attached. Your throat is numbed with a spray or gargle, which tastes bitter and makes the back of the mouth feel thick. Sedation is then given through the vein, so you feel drowsy and relaxed. Most patients remember very little afterward.

You lie on your left side. A soft mouthpiece protects your teeth and the probe. You are asked to swallow once as the probe is passed. The probe is about the width of a finger, and it slides down the esophagus rather than the windpipe, so breathing is unaffected. A suction tip clears saliva.

The cardiologist rotates and angles the probe to view the chambers, valves, and nearby vessels from several directions. Still images and video clips are recorded, and Doppler imaging measures the direction and speed of blood flow. Imaging usually takes fifteen to thirty minutes. The probe is then removed gently.

Recovery and results

You rest in a recovery area until the sedation wears off, usually about thirty to sixty minutes. Nurses check your breathing, blood pressure, and swallowing.

Do not eat or drink until your throat numbness has fully worn off, generally at least an hour. Otherwise food or liquid can go down the wrong way. Start with cool water, then move to soft foods. A mild sore throat for a day is normal. Take the rest of the day off from driving, machinery, and important decisions.

Preliminary findings are often shared before you leave. A full report is typically completed within a day or two, and Dr. Nanavati will then review the results and the plan with you. Next steps depend on what is found. They might include a medication change or further rhythm testing such as Holter monitoring. A referral for valve treatment or a scheduled structural procedure is also possible.

Risks and safety

TEE is a safe test in experienced hands, and serious complications are uncommon. The things to know are:

• Sore throat or hoarseness for a day, which is the most common effect.
• Nausea or gagging as the probe passes.
• Temporary low blood pressure, slow breathing, or drowsiness from sedation.
• Minor lip or tooth irritation from the mouthpiece.
• Temporary irregular heartbeats.
• Rarely, bleeding or injury to the esophagus, which is why swallowing history matters so much.

Call the office promptly for chest or abdominal pain, difficulty swallowing, vomiting blood, or fever after the test. MedlinePlus offers background reading on the heart conditions this study evaluates.

Related services and conditions

• Transthoracic echocardiography, the standard ultrasound through the chest wall.
• Left atrial appendage closure for selected patients with atrial fibrillation.
• Heart murmur evaluation.
• Heart anatomy explained.
• Cardiology services available across our offices.