Transesophageal Echocardiogram (TEE)

What is a TEE?

A transesophageal echocardiogram (TEE) is a test that uses sound waves to make detailed pictures of your heart and upper aorta. A TEE takes pictures from the inside of your body. While you’re sedated, your provider guides a small device down your throat. This makes TEE different from another type of echocardiogram test, called a transthoracic echo (TTE). A TTE is done outside your chest, and nothing goes into your body.

You may need a transesophageal echocardiogram if:

• Other tests didn’t show enough detail: You might’ve had a transthoracic echo, but it wasn’t enough for your provider to diagnose or manage a heart problem. A TEE provides a detailed view of your heart that some other tests can’t.
• You’re in critical condition: A TEE can help your provider learn more if you have very low blood pressure, low oxygen or your body is in shock. It can also help if you have sudden problems with your aorta, like a tear, chest trauma or issues with a prosthetic heart valve.
• You’re having a procedure to treat arrhythmia: Your provider may use TEE before you have catheter ablation or electrical cardioversion. The test can show if you have blood clots in your heart. The clots could break free during the procedure and cause serious problems.
• You’re having heart surgery: TEE is a valuable tool during certain surgeries and procedures. Your provider may use TEE before surgery to check your anatomy. They may use it after surgery to confirm success. TEE can also guide some procedures in real time.

Providers typically do a transthoracic echo first because it’s less invasive. But they may skip that and go right to using a transesophageal echo if you have:

• Chest anatomy that makes a transthoracic echo difficult
• Lung disorders
• A life-threatening emergency

How does a TEE procedure work?

Your provider guides a long, thin tube called an endoscope down your esophagus. The tube has a transducer on its tip. This is a device that makes sound waves. These waves bounce off the different areas of your heart, causing echoes. The transducer sends these echoes to a computer that turns them into pictures. These pictures show the structure and function of your heart.

Your esophagus runs behind your heart. So, it’s the perfect spot for the transducer to send and receive sound waves. A TEE is especially valuable for examining structures in the back of your heart. These include your:

• Left atrium: The top left chamber of your heart
• Left atrial appendage (LAA): The small, ear-shaped sac in your left atrium where blood clots can form
• Interatrial septum: The wall that separates your left atrium and right atrium
• Thoracic aorta: The part of your aorta that passes through your chest

Your provider may combine TEE with Doppler ultrasound and color Doppler methods. These techniques show the speed and direction of blood flow through your heart.

How do I prepare for a TEE?

Your provider will tell you how to prepare for your transesophageal echo. Their instructions will include:

• When to stop eating and drinking (usually at least six hours before the test)
• When to take your usual medications
• When to avoid alcohol leading up to your test
• Anything else you should do or avoid before your TEE

As part of your prep, you’ll talk with your provider about your health history. Some conditions make a TEE riskier to do. Tell your provider if you have:

• Esophageal cancer
• Gastritis
• GERD (chronic acid reflux)
• Hiatal hernia
• IV drug use
• Problems swallowing
• Sleep apnea
• Stomach cancer

These conditions don’t necessarily make the TEE too risky to perform, but your provider should know if these conditions exist. Also, tell your provider if you take medication for:

• Sleep issues
• Anxiety
• Pain

What to expect during the test

To perform a transesophageal echocardiogram, your provider will:

1. Ask you to put on a hospital gown
2. Place small stickers (electrodes) on your chest. which allow your provider to watch your heart’s electrical activity during the TEE
3. Put a blood pressure cuff on your arm and a pulse oximeter on your finger
4. Spray your throat with medicine that prevents pain or gagging during the test
5. Give you a sedative through an IV (through a vein in your arm) to help you relax
6. Possibly put a tube in your nose for oxygen
7. Ask you to lie on your left side on the exam table
8. Gently insert the tube — which is lubricated to help it slide down easily — in your mouth and guide it down your throat (your provider may ask you to swallow at certain points)
9. Take pictures (you shouldn’t feel any pain, but you may feel a bit of pressure in your chest)
10. Remove the tube from your throat
11. Continue to watch your blood pressure, pulse and oxygen level
12. Tell you when it’s OK to leave

A TEE may take up to 90 minutes. The picture-taking part usually only takes 15 minutes.

What are the risks of a transesophageal echocardiogram?

Possible complications include:

• Allergic reactions to medicines
• Aspiration pneumonia
• Blood pressure or heart rhythm problems
• Minor bleeding in your esophagus

Talk with your provider about the risks of a TEE before your procedure.

What can I expect after the test?

Someone will need to drive you home from your TEE. You won’t be able to drive for 24 hours after the test due to the sedation. You can expect to:

• Have a numb throat for an hour or so: This will wear off. Don’t eat or drink anything until the numbness goes away. You might choke if you eat or drink too soon.
• Have a sore throat: This is normal after the numbness wears off. It may last anywhere from a few hours to a few days. If the soreness doesn’t go away or gets worse, call your provider.

Your provider will tell you when the test results will be available.

What does a TEE show?

A transesophageal echocardiogram shows a detailed view of your heart’s structure and function. The results may help your provider diagnose a wide range of conditions, including:

• Aortic aneurysm: This is a bulge in the artery that carries blood away from your heart.
• Blood clots: These are clumps of blood that can form anywhere in your body. A TEE can check for them in your heart chambers.
• Congenital heart disease: These are heart issues that you’re born with.
• Heart tumors: These are growths that can develop in your heart. They may be cancerous or noncancerous.
• Heart valve disease: One of your valves may be narrowed or leaky. A TEE can also spot problems with prosthetic valves, like growths or infections.
• Infective endocarditis: This is a dangerous infection in your heart.
• Pericarditis: This means the sac around your heart is inflamed.

Are you awake during a TEE?

You’re awake but drowsy. Your provider will sedate you to make you feel more comfortable during the test. Most people don’t need general anesthesia (deep sleep). If you do receive it, you’ll be fully asleep and won’t remember the procedure. But recovery may take longer compared with moderate sedation.

Is TEE a major surgery?

No. It’s a diagnostic test that checks your heart. A TEE is an invasive procedure because your provider needs to put a device inside your body, but it’s not surgery. You may experience mild discomfort. But the risk of serious problems is low.