South Bay Cardiovascular Center

Tests

Transesophageal Echocardiography

Transesophageal echocardiography (TEE) is a test that uses sound waves to create very high-quality moving pictures of the heart and its blood vessels. The test can be used for adults and children.

Transesophageal_Echocardiography

Figure A shows a transesophageal echocardiography probe in the esophagus, behind the heart. Sound waves from the probe create high-quality pictures of the heart. Figure B shows an echocardiogram of the heart’s lower and upper chambers (ventricles and atrium, respectively).

  • TEE is a type of echocardiography (echo). Echo provides information about the size and shape of the heart and how well the heart chambers and valves are working.
  • TEE may be used in addition to transthoracic echo (TTE), the most common type of echo. If TTE pictures don't give doctors enough information, they may recommend TEE to get more detailed pictures.
  • TEE can help diagnose a heart or blood vessel disease or condition. Doctors also may use TEE to assist with cardiac catheterization or to help prepare for surgery or assess a patient's status during and/or after surgery.
  • TEE most often is done in a hospital. You usually will need to fast (not eat or drink) for 8 hours prior to the test. Talk with your doctor about whether you or your child needs to take any special precautions before having TEE.
  • You may be given medicine to help you relax during TEE. If so, you'll have to arrange for a ride home after the test because the medicine can make you sleepy.
  • During TEE, a flexible tube (probe) with a transducer at its tip is used. The probe is guided down your throat and into your esophagus (the passage leading from your mouth to your stomach). This allows your doctor to get detailed pictures of your heart.
  • TEE takes less than an hour. However, you may be watched for a few hours after the test because of the effects of the medicine used to help you relax during the test.
  • You or your child can likely go home a few hours after having TEE. You may have a sore throat for a few hours after the test. You shouldn't eat or drink for 30 to 60 minutes after having TEE. Most people can return to their normal activities within about 24 hours of the test.
  • TEE has a very low risk of serious complications in both adults and children. Even newborns can have TEE. To reduce your risk, your heart rate and other vital signs will be carefully checked during the test.
  • Some risks are associated with the medicine given to help you relax during TEE. You may have a bad reaction to the medicine, problems breathing, or nausea (feeling sick to your stomach). Usually, these problems go away without treatment.

What Is Transesophageal Echocardiography?

Transesophageal echocardiography, or TEE, is a test that uses sound waves to create high-quality moving pictures of the heart and its blood vessels. TEE is a type of echocardiography (echo). Echo shows the size and shape of the heart and how well the heart chambers and valves are working. Echo can pinpoint areas of heart muscle that aren't contracting well because of poor blood flow or injury from a previous heart attack. Echo also can detect possible blood clots inside the heart, fluid buildup in the pericardium (the sac around the heart), and problems with the aorta. The aorta is the main artery that carries oxygen-rich blood from your heart to your body.

Who Needs Transesophageal Echocardiography?

Doctors may recommend transesophageal echocardiography (TEE) to help diagnose a heart or blood vessel disease or condition. TEE can be used for adults and children.

Doctors also may use TEE to guide cardiac catheterization, help prepare for surgery, or assess a patient's status during or after surgery.

Transesophageal Echocardiography as a Diagnostic Tool

TEE helps doctors detect problems with the structure and function of the heart and its blood vessels.

In general, transthoracic echo (TTE) is the first echo test used to diagnose heart and blood vessel problems. However, you might have TEE if your doctor needs more information or more detailed pictures than TTE can provide.

For TTE, the transducer (the device that sends the sound waves) is placed on the chest, outside of the body. This means the sound waves may not always have a clear path to the heart and blood vessels. For example, obesity, scarring from previous heart surgery, or certain lung problems (such as a collapsed lung) may block the sound waves.

For TEE, the transducer is at the tip of a flexible tube (probe). Your doctor will guide the probe down your throat and into your esophagus (the passage leading from your mouth to your stomach).

This approach allows your doctor to get more detailed pictures of your heart because the esophagus is directly behind the heart.

Doctors may use TEE to help diagnose:

  • Coronary heart disease
  • Congenital heart disease
  • Heart attack
  • Aortic aneurysm 
  • Endocarditis 
  • Cardiomyopathy 
  • Heart valve disease
  • Injury to the heart or aorta (the main artery that carries oxygen-rich blood from your heart to your body)

TEE also can show blood clots that may have caused a stroke or that may affect treatment for atrial fibrillation, a type of arrhythmia.

Transesophageal Echocardiography and Cardiac Catheterization

Cardiac catheterization is a medical procedure used to diagnose and/or treat certain heart conditions. During this procedure, a long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck and threaded to your heart. Doctors may use TEE to help guide the catheter while they're doing the procedure. Through the catheter, doctors can do tests and treatments on your heart. For example, cardiac catheterization might be used to repair holes in the heart, heart valve disease, and abnormal heart rhythms.

Transesophageal Echocardiography and Surgery

Doctors may use TEE to prepare for a patient's surgery and identify possible risks. For example, they may use TEE to look for possible sources of blood clots in the heart or aorta. Blood clots can cause a stroke during surgery. TEE might be used in the operating room after a patient receives medicine to make him or her sleep during the surgery. The test can show the heart's structure and function and help guide the surgery. TEE also helps doctors assess a patient's status during surgery. For example, TEE can help check for blood flow and blood pressure problems. At the end of surgery, TEE might be used again to check how well the surgery worked. For example, TEE can show whether heart valves are working well. TEE also can show how well the heart is pumping. People having surgery that isn't related to the heart also may have TEE to check their heart function if they have known heart disease or a critical illness.

What to Expect

Before

Transesophageal echocardiography (TEE) most often is done in a hospital. You usually will need to fast (not eat or drink) for several hours prior to the test. Your doctor will let you know exactly how long you should fast. You should let your doctor know whether you're taking any blood-thinning medicines, have trouble swallowing, or are allergic to any medicines. If you have dentures or oral prostheses, you'll need to remove them before the test. You may be given medicine to help you relax during TEE. If so, you'll have to arrange for a ride home after the test because the medicine can make you sleepy.

Talk with your doctor about whether you need to take any special steps before having TEE. Your doctor can tell you whether you need to change how you take your regular medicines on the day of the test or whether you need to make other changes.

During

During transesophageal echocardiography (TEE), your doctor or your child's doctor will use a probe with a transducer at its tip. The transducer sends sound waves (ultrasound) to the heart. Probes come in many sizes; smaller probes are used for children and newborns. The back of your mouth will be numbed with gel or spray before the probe is put down your throat. You may feel some discomfort as the probe is guided into your esophagus (the passage leading from your mouth to your stomach). Adults having TEE may get medicine to help them relax during the test. The medicine will be injected into a vein. Children always receive medicine to help them relax or sleep if they're having TEE. This helps them remain still so the doctor can safely insert the probe and take good pictures of the heart and blood vessels. Your doctor will insert the probe into your mouth or nose. He or she will then gently guide it down your throat into your esophagus. Your esophagus lies directly behind your heart. During this process, your doctor will take care to protect your teeth and mouth from injury.

Your blood pressure, blood oxygen level, and other vital signs will be checked during the test. You may be given oxygen through a tube in your nose. TEE takes less than an hour. However, if you received medicine to help you relax, you might be watched for a few hours after the test for side effects from the medicine.

After

After having transesophageal echocardiography (TEE), your or your child's blood pressure, blood oxygen level, and other vital signs will be closely watched. You can likely go home a few hours after having the test. After the TEE, you may have a sore throat for a few hours. You shouldn't eat or drink for 30 to 60 minutes after having TEE. Most people can return to their normal activities within about 24 hours of the test. Talk with your doctor for more detailed information about what to expect after having TEE.

What Does Transesophageal Echocardiography Show?

Transesophageal echocardiography (TEE) provides very high-quality moving pictures of your heart and blood vessels. These pictures help doctors detect and treat heart and blood vessel diseases and conditions. TEE creates pictures from inside the esophagus (the passage leading from the mouth to the stomach) or, sometimes, from inside the stomach. Because the esophagus lies directly behind the heart, TEE provides closeup pictures of the heart. This imaging position also offers different views and may provide more detailed pictures than transthoracic echocardiography (TTE), the most common type of echo. (For TTE, the transducer is placed on the chest, outside of the body.)

Your doctor may recommend TEE if he or she needs more information than TTE can provide. TEE can help diagnose and assess various heart and blood vessel diseases and conditions in adults and children.

What Are the Risks of Transesophageal Echocardiography?

Transesophageal echocardiography (TEE) has a very low risk of serious complications in both adults and children. To reduce your risk, your health care team will carefully check your heart rate and other vital signs during and after the test.

Some risks are associated with the medicine that might be used to help you relax during TEE. You may have a bad reaction to the medicine, problems breathing, or nausea (feeling sick to your stomach). Usually, these problems go away without treatment.

Your throat also might be sore for a few hours after the test. Although rare, the probe used during TEE can damage the esophagus (the passage leading from your mouth to your stomach).


Reference: The National Heart Lung and Blood Institute

Last updated May 1, 2017