The transesophageal cardiogram (TEE) is a diagnostic test used to check heart function. Sound waves create images of the heart’s valves, chambers, pericardium, and blood vessels that show heartbeats and blood flow. An echo transducer creates sound waves for the transesophageal echocardiogram. It is connected to the thin tube that passes from a person’s mouth to the throat to his esophagus. In addition, the esophagus is adjacent to the heart’s upper chamber, which helps to get clear pictures of the heart valves and their structures.

The doctor suggests transesophageal echocardiography to get a clear picture of the heart, which cannot be achieved through a standard echocardiogram. TEE is used ultrasound waves to produce detailed images of a person’s heart and arteries. Furthermore, TEE gives information on repairing the heart valves and treating arrhythmias and congenital heart defects. The more explicit pictures taken by TEE may help the doctor to evaluate the heart’s structure and diagnose different conditions, such as:

  • The size of a person’s heart and its thickened walls.
  • The pumping capacity of the heart.
  • The abnormal tissue surrounds a person’s heart valves, indicating cancer or viral, fungal, or bacterial infections.
  • Regurgitation (a backward leaking of blood from the heart valves).
  • Stenosis (valves become stiff or narrow and can’t open properly).
  • Cardiac tumors that can be cancerous or noncancerous.
  • Blood clotting in the heart’s chambers. The atrial fibrillation patient has high-risk factors of clots in his aorta.
  • Aortic aneurysm (a bulge in the aorta wall).
  • Pericardial disease.
  • Infective endocarditis (bacterial infection within the heart’s inner lining and valves).

Why do we need TEE?

The transesophageal echocardiogram is used for different purposes depending upon the person’s condition. Doctors have suggested TEE when a particular part of a heart requires to be evaluated with higher resolution. These may include:

  • TEE is used to diagnose and manage cardiac diseases.
  • If a person has a life-threatening condition and his doctor requires a detailed evaluation. A TEE has been helpful in critical care and emergencies such as hypotension, hemodynamic instability, heart attack, aortic dissection, or hypoxia.
  • A doctor requires examining blood clots before giving a medical treatment such as cardioversion.
  • TEE is useful in percutaneous procedures such as mitral valve repair or transcatheter tricuspid valve replacement.
  • If a person needs surgery for coronary valve replacement or repair, TEE helps doctors to evaluate the success rate of surgery.
  • TEE can also be used for lung disorders.

How to prepare for TEE?

You must visit the doctor to discuss your medical condition and the medicines you are currently using. Certain medical disorders, such as gastritis, hiatal hernia, and esophageal or stomach cancer, can make the TEE very difficult to perform. In addition, he must tell his doctor if he is allergic to medications, latex, or local anesthesia. For which, the doctor will give detailed guidelines to prepare for TEE according to the medical condition, such as:

  • Avoid taking alcoholic drinks for some days before the TEE.
  • Stop drinking and eating for at least 6 hours before a test.
  • Take someone to the hospital along with you who can drive back home because driving may not be safe after the test.
  • Consuming the prescribed medications with a little sip of water.

What is the mechanism of TEE?

TEE is performed in a clinic or hospital that takes almost 30-60 minutes. The procedures can vary depending upon the medical condition of a person. Following are the steps of TEE:

  • The patient must remove the jewelry because it interferes with the TEE procedure.
  • The patient is asked to wear a gown.
  • The patient is advised to empty his bladder before TEE.
  • The specialist applies a local anesthetic spray to a patient’s throat to prevent gag reflux.
  • The patient lies on a bed or table (positioned on his left side), and the pillow is placed behind his back.
  • A patient is attached to the ECG monitor to detect electrical signals and the heart’s rhythm. Sensors (electrodes) are attached at different points of the chest, and wires connect electrodes to the computer that records the heart rate and tracks the heartbeat.
  • The intervenous IV gives the patient a sedative for relaxation.
  • Oxygen is administered by nasal tubes.
  • The room is darkened as the doctor needs to evaluate the pictures on the ECG.
  • A doctor inserted a flexible thin tube (probe) in the patient’s mouth and asked him to swallow down his throat.
  • The specialist takes the images.
  • The patient can feel pressure in his chest as the specialist proceeds a transducer in certain positions.
  • After taking the images, he removed the probe and electrodes from a patient’s throat.
  • The patient is moved to the recovery room to monitor his heart rate, oxygen level, ECG, and blood pressure.
  • After completing the procedure, the patient is discharged from the hospital. He can feel tired or weak after the procedure, but that will gradually improve.

Risk factors of TEE:

Following are the possible risk factors of TEE:

  • Sore throat
  • Bleeding in the esophagus
  • Heart arrhythmias
  • Breathing problems like aspiration pneumonia
  • Injury in the mouth, teeth, throat, and esophagus

 

 

 

 

 

References

  • https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/transesophageal-echocardiography-tee
  • https://my.clevelandclinic.org/health/diagnostics/4992-echocardiogram-transesophageal-tee
  • https://stanfordhealthcare.org/medical-tests/t/transesophageal-echocardiogram.

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/transesophageal-echocardiogram