Transesophageal Echocardiography (TEE)

Cardiac ultrasound, or echocardiogram, is an examination that allows the evaluation of the heart’s anatomy and function using ultrasound.

Just like pregnant women

It is an examination of the same nature as the one used to see the baby in pregnant women. In this case, it is the heart that we will see.

The lungs and the bones hide the heart during an ultrasound

The heart is a solid organ located within the thorax, surrounded by air (the lungs) and bone (the ribs). These latter structures do not allow the transmission of ultrasound waves, making the examination more complex. Therefore, a limited number of anatomical windows are used, which are specific locations on the chest where the probe can be applied to visualize the heart without the interference of the lungs and bones.

Two methods

There are two ways to perform a cardiac ultrasound.

• Transthoracic (ETT)

In one method, the cardiac ultrasound probe is placed on the chest, and the ultrasound waves pass through the thorax. This is known as transthoracic echocardiography.

• Transesophageal (EET)

In the transesophageal technique, the probe is placed in the esophagus, which is the tube that connects the mouth to the stomach. This way, the masking effect of the lungs and bones is avoided.

Similar to a gastroscopy, the probe is “swallowed” under sedation, of course

Transesophageal Echocardiography (TEE)

When a doctor needs to examine certain heart structures with greater precision than a transthoracic echocardiogram, they may recommend a transesophageal echocardiography (TEE).

This exam is particularly effective for observing the inside of the left atrium, left ventricle, and heart valves. Thanks to this technique, the images obtained are more detailed, allowing for better detection of potential abnormalities that may be difficult to visualize with a standard echocardiogram performed through the chest wall.

Scheduling an Appointment

An appointment is required for this exam. It is important to schedule it according to medical recommendations to ensure the procedure goes smoothly.

What to Know Before the Exam

Before undergoing a transesophageal echocardiography (TEE), it is essential to fast from midnight the night before the exam. This precaution helps obtain clear images and prevents any discomfort during the procedure.

Once the exam is completed, you can usually resume your regular medications, unless otherwise instructed by your doctor.

Since sedation is involved in the procedure, it is strongly recommended to have someone accompany you home. Driving or engaging in activities requiring increased alertness is not advised for several hours after the exam.

The Day of the Exam

Upon arrival, you will be asked to remove any clothing covering your chest and put on a hospital gown. The examination room is intentionally dimly lit to enhance image visualization during the procedure.

The exam, which lasts about 30 minutes, is performed by a cardiologist with the assistance of a medical imaging technologist.

Important Information to Share

Before the procedure begins, it is crucial to inform the medical team of any known allergies.

Additionally, if you have undergone esophageal surgery in the past, it is essential to mention it to the doctor or technologist. Certain prior interventions may present contraindications, making the exam unsuitable or risky.

Preparation

Before the exam begins, a venous catheter is inserted into your arm to administer medication that helps you relax and reduces any stress or anxiety.

The technologist places three electrodes on your chest. These small sensors record your heart’s electrical activity throughout the exam, ensuring real-time monitoring of its function.

A Gargle Before the Procedure

To minimize throat discomfort, a medicated gargle is administered before the examination. This anesthetic solution provides a mild numbing effect, similar to throat lozenges used for sore throats.

Throughout the procedure, you will be lying on your left side, a position that facilitates the insertion and positioning of the probe.

A Sedative to Help You Relax

A sedative is given to promote relaxation, but it does not put you into a deep sleep. You will remain awake and able to follow the medical team’s instructions during the procedure.

The Examination Itself

The transesophageal echocardiogram (TEE) is performed using a well-lubricated probe, which is carefully inserted into the mouth and then into the throat. You will be asked to swallow to help guide the probe downward. Due to the local anesthetic applied earlier, swallowing may feel slightly difficult, but this is completely normal.

The probe, about the size of a small finger, contains ultrasound sensors that allow real-time imaging of the heart and bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flow. Once positioned in the esophagus, just behind the heart, it captures highly detailed images.

During the Exam

It is normal to produce saliva during the procedure. It is recommended to let it flow naturally rather than swallowing, as this can affect image clarity. A towel is placed to absorb excess saliva.

To optimize image quality, it is best to avoid swallowing as much as possible, as this can interfere with the sharpness of the images. The clearer the images, the faster and more efficiently the exam can be completed.

Key Information Assessed

This technique allows the cardiologist to examine the heart’s internal chambers, the valves and their function, as well as the large bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood vessels connected to the heart.

TEE is particularly useful for detecting congenital abnormalities, as the high-resolution images provide a clearer assessment.

Unlike angiography, this exam does not visualize the coronary arteriesThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that, as they are too small to be captured by ultrasound technology.

Why Choose TEE Over a Transthoracic Echocardiogram?

A transesophageal echocardiogram (TEE) provides much clearer images than a transthoracic echocardiogram because it avoids interference from the air in the lungs.

This technique allows for a more precise diagnosis, especially when a standard echocardiogram performed through the chest wall does not provide sufficient detail.

What does it look like?

End of the Exam

Once the procedure is completed, the probe is gently removed, and you will be given a towel to clean yourself.

The electrodes and the IV catheter inserted into your vein will also be removed, marking the end of the procedure.

Post-TEE Instructions

It is recommended not to eat or drink for at least two hours after the exam. Since the local anesthetic applied to the throat is still active, swallowing could be impaired, increasing the risk of choking on food or liquids. It is essential to wait until all numbness has completely disappeared before resuming normal eating and drinking.

For returning home, it is advisable to have someone accompany you, especially due to the sedation received during the procedure. This precaution ensures a safer and smoother recovery.