Transesophageal Echocardiogram (TTE)

What is Transesophageal Echocardiogram (TTE)?

A transesophageal echocardiogram (TEE) is a diagnostic procedure used to asses the condition and function of the heart using high frequency waves.

This is done in a hospital setting where images of your heart are recorded by introducing an ultrasound transducer into the esophagus.

Why do I need this?

A TEE may have been ordered for you to obtain a more detailed image of your heart compared to a transthoracic echocardiogram done over the chest.

The transmission of beams to the heart may be difficult to reach in patients with over-crowding of the ribs, obesity, or emphysema.

In a transesophageal approach, the esophagus sits directly behind the heart without having to pass through any barriers.

When is it used?

A transesophageal echocardiogram may show signs of:
 
  • Congenital heart defects
  • Previous heart attacks
  • Blood clots in the heart
  • Infection of the heart valves
  • May explain chest pain discomfort or shortness of breath
  • May explain the cause on an irregular heartbeat or heart sound
  • Determines the overall strength of contractions of the heart
  • Pericardial effusion (fluid around the heart)
  • Presence of a cardiac mass
  • Determines whether cardioversion is required
  • Detects the presence of an ascending aorta dissection or aneurysm

What are the risks?

TEE is a common diagnostic procedure, although with any medical procedure it carries risks.
 
These include:
 
  • Allergic reaction: to the medication or latex
  • Infection
  • Dental injury
  • Pharyngeal/ laryngeal trauma
  • Esophageal trauma or bleeding
  • Arrhythmia (irregular heart beat)
  • Respiratory distress (breathing difficulty)
Notify the physician if you have known esophageal problems (i.e. difficulty in swallowing) or have undergone any radiation to the esophagus.
 
Let your physician know if you have any bleeding disorders.
 
If you are pregnant or suspect you may be pregnant, let the physician know.
 
If you are allergic to any medications or to latex notify the physician.

How do I prepare for this procedure?

The possible risks and benefits will be explained to you and any questions you or your family may have will be answered before your procedure.

You will be asked to have blood work done some time before the procedure.

You will be asked to sign a consent form to perform the diagnostic procedure.

Remove nail polish, necklaces, rings, bracelets, and any other jewelry before the procedure.

Do not eat or drink anything from midnight the night before your procedure. You may have small sips of water to take your medicine. The procedure is usually done in the morning. This is done to reduce the risk of vomiting and aspiration during the procedure.

A sedative will be given to you prior to the procedure to help you relax.

Make arrangements to have someone drive you to and from the hospital. You will not be permitted to drive after the procedure.

You will be asked to empty your bladder before the procedure.

The procedure is done on an outpatient basis so you will leave the same day as the procedure.

What happens during the procedure?

The procedure will take place in the hospital in the ECHO lab.

You will be asked to change into a hospital gown before entering the lab.

An I.V. line will be started in your hand or arm for the administration of a sedative.

You will lie on your back on a table and a pillow may be wedged underneath your back.

A local anesthetic spray will be applied to the back of your throat. This will make the back of your throat numb so you will feel more comfortable while the probe is being passed down your throat.

If required, oxygen may be administered through nasal tubes.

Then, you will be asked to lie on your left side.

The physician gently inserts a well lubricated probe into your mouth. You may be asked to swallow to help pass the probe down the esophagus.

Once the probe is in position, images of the heart can be obtained. This does not hurt or interfere with your breathing.

Throughout the procedure your heart rate, blood pressure, and oxygen will be closely monitored.

The procedure usually lasts 30 minutes, but the prep time may take longer.

What happens after the procedure?

Once the procedure is completed, you will be moved into a recovery area where your heart rate, blood pressure, and oxygen levels will be monitored.

Wait at least one hour after the procedure or until your throat is no longer numb to eat and drink again.

You may resume your daily activities after the procedure is completed.

No driving permitted for 24 hours.

Be sure to keep to your follow up appointment.

The result:

The results of your study will be reviewed to look for healthy heart valves and chambers, as well as normal heart functioning.
 
This is useful in planning for your treatment and also helps in determining whether further testing is needed.
 
A transesophageal echocardiogram may reveal:
 
  • The size of the heart and the chambers of the heart
  • The thickness and motion of the ventricular walls
  • The movement and function of the of the heart valves
  • The cardiac output (volume of blood pumped out of the heart per minute)
  • The pressures within various chambers of the heart and major blood vessels in the heart
  • The blood flow within the heart
  • The heart function changes over time
  • The presence of blood clots inside the heart
The results of your ECHO will be discussed with you during your office visit.