24 May 2018
TRANS OESOPHAGEAL ECHOCARDIOGRAM
A cardiac ultrasound, or echocardiogram, allows the evaluation of someone’s anatomy and heart condition.
Just like pregnant women
It is the same type of test used to examine a baby in a pregnant woman. In the case of a cardiac ultrasound, the heart is organ of interest.
Two different methods can be used to perform an echocardiogram.
The first method consists of placing the electrodes on the chest. The ultrasounds will penetrate through the thorax, hence the term “cardiac transthoracic ultrasound”.
The transesophageal technique implies that the probe passes through the oesophagus, the internal part of the body that connects the mouth to the stomach. By doing so, the lungs and bones do not interfere in the testing. As is done when a gastroscopy is performed, the probe is “swallowed” by the sedated patient.
The Trans Oesophageal Echocardiogram
A doctor may ask that this exam be done in order to better analyse certain parts of your heart that were not well seen at the transthoracic echocardiogram.
It is a very good exam to see the interior of the left atrium and ventricle as well as the cardiac valves.
Make an appointment
An appointment is necessary for this exam.
Preparation and sedation needed for the exam
For a trans oesophageal echocardiogram, you must have an empty stomach as of midnight the previous evening. You may take your regular medication after the exam.
Someone must accompany you after the exam because of the sedation medication you will be given prior to the exam.
The test lasts approximately 30 minutes.
Upon your arrival
Upon your arrival, you will remove your upper-body clothing and to put on a hospital gown. The purposely dimly lit examination room makes it easier to see the images.
The test is administered by the heart specialist assisted by the medical imagery technician. The results are transmitted to the treating clinician.
The technician installs three electrodes, or electronic sensors, on your thorax that allow the recording of your heart’s electrical flow.
A catheter is installed in a vein in your arm so a medication that helps you relax can be administered in order to calm stress or anxiety.
You must mention to your doctor or to the technologist if you have any known allergies.
It is also important to mention to the doctor or to the technologist if you have ever had surgery on your oesophagus, in other words, on the canal that connects your mouth to your stomach. Certain past surgeries may be a contraindication, a danger for this type of exam.
Gargling before beginning
Before starting the exam, you are asked to gargle using a medication that reduces the feelings in your throat. Your throat will be “frozen”. It resembles taking lozenges for a sore throat.
You will lie on your back and turned on your left side during the entire exam.
A sedative to relax
Even with the medication to help you relax, you will not fall asleep during the exam.
Do not worry about the saliva produced during the exam. Let it drip out of your mouth. The technologist will have installed a towel for this.
The images of the ultrasound are altered if the patient swallows. Just remember that the clearer the images, the quicker the exam ends.
The actual exam
The exam is done with a well-lubricated probe that is introduced inside the mouth, then down the throat as you swallow.
It is possible that you have difficulty swallowing because of the gargling you did earlier. Don’t worry about it.
The probe is approximately the size as your pinky. It has ultrasound sensors on it that allows the heart and blood rate to be observed.
Once swallowed, the probe slides in the oesophagus where the images are taken.
The images are much clearer that those taken from the surface of the thorax. The constraints caused by the air in the lungs are avoided.
The doctor will ask to try not to swallow your saliva.
Let it drip from your mouth on the towel the technologist will have installed prior to the exam.
On the lookout for lots of information
Many heart measurements are taken that allow for an estimation of the size of the heart, the inside of each cavity, the contraction of the heart muscle, the four valves and the large vessels entering and exiting your heart.
The search for congenital anomalies is easier using this method because of the quality of the images obtained.
The coronary arteries are not visible because they are too small.
Here are some examples of collected images
Mild regurgitation - look at the orange spot at the center of the valve, pointing to the right
Mitral valve above, aortic valve below
Aortic valve, viewed from above
Aortic valve and aorta - side view
The trans oesophageal echocardiogram reveals multiple, relevant information to your doctor that will allow him or her to confirm or infirm certain diagnostics obtained from the trans thoracic echocardiogram.
End of the exam
At the end of your exam, the probe is taken out of your throat and you are handed a towel to wipe yourself. The electrodes and the catheter are removed as well.
You are asked not to eat or drink for the next two hours. Your throat is numb because of the anaesthetic medication. You must wait for the medication to lose its effect so that you don’t choke when swallowing liquids or food.
If somebody is accompanying you, you may return home quicker than if you don’t have someone with you.
You may ask for a copy for another doctor
It is possible to ask that a copy of your results be sent to another doctor.
You simply must give the doctor’s name and contact information to the personnel before or after your exam.