The abbreviation TEE is often used by the medical profession for this examination.
An echocardiogram, or cardiac ultrasound, is an imaging test that uses ultrasounds produced by a probe. When ultrasounds come into contact with a structure in the body, they produce echos that are specific to the surface encountered. The probe is linked to a computer, which analyzes the various echoes and assembles them to form images in real time.
Ultrasounds have a frequency of 20,000 Hz which cannot be heard by the human ear.
A transesophageal echocardiogram is first and foremost a cardiac ultrasound, performed by a cardiologist, used to visualize, analyze and measure images of the heart (cavities, valves, walls, etc.) in real time.
The peculiarity of a transesophageal echocardiogram is that it uses a very small ultrasound sensor, placed at the end of a fiberscope. This device, commonly used to examine the stomach or esophagus, is “swallowed” by the patient. Given that the esophagus is directly next to the heart, the cardiologist can carry out a more detailed analysis of the functioning of the heart and the aorta as well as of small structures that sometimes cannot be seen on a cardiac ultrasound.
This semi-invasive examination, performed under anesthesia, plays an important role in the diagnosis and management of patients.
This examination may be combined with a classic cardiac ultrasound (TTE) to complete the diagnosis.
Why have a transesophageal echocardiogram?
It is relatively rare for a transesophageal echocardiogram to be performed. This examination is carried out in the following situations:
- Stroke assessment,
- Suspicion of heart valve infection,
- Prior to an external electric shock – initiated by the cardiologist to restore a normal cardiac rhythm,
- Looking for a clot in the heart,
- Malfunction of a cardiac prosthesis,
- Suspicion of an aortic wall anomaly (clot, tear, etc.),
- Etc.
How to prepare for it?
Patients must fast for at least 6 hours prior to and during a transesophageal echocardiogram. Only medications may be taken (unless advised otherwise by a doctor) with a small amount of water and, if possible, not too close to the time of the examination.
How does the exam take place?
The exam can be performed in an examination room in a hospital or clinic.
A transesophageal echocardiogram lasts for a total of 60 minutes: this includes the preparation, anesthesia and image acquisition. In most cases, the tube is only placed in the esophagus for less than 10 minutes.
The patient lies down on an examination table before being anesthetized.
There are two possible types of anesthesia:
- local anesthesia of the pharynx (throat), administered via an anesthetic spray a few minutes before the ultrasound scan.
- brief general anesthesia (light sedation) administered intravenously.
The probe is then gently introduced, through a bite block, by the cardiologist and the patient helps the probe move down the throat by swallowing.
A transesophageal echocardiogram is not painful if the patient is under general anesthesia. Without anesthesia, patients may experience some discomfort and nausea. Patients may have throat pain, similar to a sore throat, in the hours and days following the examination.
The patient must continue to fast for 2 hours after the examination to allow the anesthesia to wear off, and can then return home.
This examination is contraindicated for patients:
- With esophageal disorders,
- At high risk of bleeding (hemorrhage),
- Allergic to rubber (the sheath used is made of rubber),
- With swallowing problems or dysphagia,
- With a severe cervical pathology,
- Presenting respiratory instability,
- Who have recently had esophagogastric surgery,
- With a full stomach.
It is recommended to not drive for 4 hours after a transesophageal echocardiogram.
Reviewed and approved by Marine Arnaud, MD, Cardiologist at Bordeaux University Hospital (CHU)
