Transesophageal Echocardiography (TEE)

A transesophageal echocardiogram (TEE) uses sound waves bounced off the heart to create a moving picture of the heart and blood vessels. A long, flexible tube about the width of a little finger is inserted into your mouth, then into the esophagus — the tube that connects the throat to the stomach, directly behind the heart.

This probe has a tiny device at its tip called a transducer that sends and records the sound waves. This creates pictures of your heart and blood vessels from inside the esophagus, rather than through the wall of the chest. The images are sometimes clearer than those from a regular echocardiogram because they are taken from closer to the heart.

Sometimes these scans are done in the operating room to provide real-time feedback to surgeons about the health and functioning of the heart and its valves, allowing them to make appropriate choices at the time of surgery.

This test is used to:

  • Detect blood clots or masses inside the heart
  • Assess heart valves and artificial heart valves
  • Detect holes between the chambers of the heart
  • Diagnose tears in the lining of the aorta
  • Detect infections in the heart valves
  • Identify potential causes of stroke
  • Evaluate heart size
  • Identify areas of poor blood flow in the heart
  • Examine previous injury to heart muscle

What happens during this procedure?

The TEE begins with an anesthetic sprayed into the throat to numb it. Then, the patient lies on an examination table and an IV is placed in their arm. Patients will get a drug to help them relax during the test. Then, they’re connected to an electrocardiogram machine that will monitor the heart during the test, and they will wear a blood pressure cuff. Oxygen will be delivered to the nose through tubing called a cannula.

Then, the small flexible tube will be put down the patient’s throat, and the doctor will ask them to swallow to gently move the probe down the throat.

The transducer sends sound waves into the chest and picks up echoes that bounce back from different parts of the heart. These sound waves are converted into images on a television monitor and recorded.

The physician may move the probe around to get pictures of the heart from different angles.

Does the test cause discomfort?

Although patients are given a sedative and their throats are numbed before insertion, they may still feel the probe as it is moved down the throat into the esophagus. This sensation is not painful, but it is quite common to feel the need to gag. This is normal.

How long will the test take?

The test takes about 30 minutes, and patients then will spend at least an hour recovering in the examination room. Those getting the test on an outpatient basis should plan on being at the medical center for at least two hours.

What preparations are needed before a TEE?

Patients undergoing a TEE should prepare in the following ways:

  • Do not eat or drink anything for three to four hours prior to the test.
  • Wear comfortable, easy-to-remove clothing, because all patients must change into a hospital gown before undergoing the test.
  • Be sure the doctor is aware of all medications the patient is taking before they come in for the test. He or she may ask that some be skipped prior to the TEE.
  • Patients will need to remove dentures or any other oral prosthesis because they may interfere with the test.
  • People undergoing TEE must have someone drive them home. Operating a vehicle is prohibited for 24 hours after sedation.

What will happen after the test is complete?

After the test, patients remain in the examination room for 60 minutes to recover from the medication. It is OK to fall asleep during this time.

Do not eat or drink anything for an hour after being released, or until the throat is no longer numb.

Some patients have a sore throat or trouble swallowing after the procedure. This is normal. Patients should drink something cold or let a throat lozenge dissolve in their mouth to soothe any discomfort. This lasts about a day.

Patients who experience pain or bleeding, however, should report these symptoms to their doctor.