Definition

An Trans-esophageal Echocardiogram (TEE) is an ultrasound scan of the heart using a long thin tube that is advanced down the esophagus (food pipe) to the back of the heart under moderate sedation. This provides high definition pictures of the heart chambers and valves without the ribs or lungs obstructing the view.

What are the benefits of a TEE?

The TEE provides a more detailed evaluation of the heart, providing more information to our doctor to guide and optimize your treatment.

The test is used to

  1. 1
    Assess the overall pumping function of the heart eg
  • Presence and aetiology of heart failure
  • How well the heart pumps after a heart attack
  1. 2
    Determine the presence of any structural heart disease eg.
  • Congenital heart diseases (“Holes in the heart”)

  • Valvular heart diseases (Disorders of the heart valves)
  • Myocardial diseases (Disorders of the heart muscle)
  • Pericardial diseases (Disorders of the outer lining of the heart)
  1. 3
    Diagnose underlying Coronary Artery Disease (CAD)
  1. 4
    Diagnose infections affecting the heart eg.
  • Infective endocarditis (Infections of the heart valves)

  • Myocarditis (Infection of the heart muscles)
  • Pericarditis (Infection of the outer lining of the heart)
  1. 5
    Diagnose clots in the heart that can lead to major strokes
  2. 6
    Diagnose cardiac tumors eg atrial myxomas
  3. 7
    Evaluate the progression of valve disease over time
  4. 8
    Guide heart valve surgeries and electrophysiological procedures.
  5. 9
    Assess how well the heart valves are working after surgery

Figure A – Shows a transesophageal echocardiography probe in the esophagus, which is located behind the heart. Sound waves from the probe create high-quality pictures of the heart.

Figure B – shows an echocardiogram of the heart’s lower and upper chambers (ventricles and atrium, respectively).

Example of a TEE revealing Aortic Dissection (tear in the inner lining of the Aorta)

Example of a TEE revealing Infective Endocarditis (Infection) of the Mitral Valve

Example of a TEE revealing Left Atrial Myxoma (tumor arising within the heart)

Who will benefit from this test?

  • Patients with valvular heart disease planning for valve repair or replacement
  • Patients with clinical features to suspect
  1. Infective endocarditis (infection of the heat valves)
  2. Aortic dissection (tear in the inner lining of the aorta)
  3. Prosthetic valve dysfunction
  4. Cardioembolic stroke (Clot in the heart resulting in a stroke)
  • Patients undergoing percutaneous cardiac interventions like:
  1. Closure of Atrial Septal Defects (ASD) or Patent Foramen Ovale (PFO)
  2. Valvuloplasty
  3. Transcatheter Aortic Valve Replacement (TAVR)

How to prepare for the test

  • When the test is recommended for you, please inform our doctor if you have any problem with your esophagus such as problems swallowing, hiatal hernia or cancer.
  • Please plan to bring someone with you on the day of the test so that you will have a ride home. You should not drive until the day after the test, as the sedation given during the test makes it unsafe for you to drive after the test.
  • Fasting from food and drinks is required for at least 6 hours before the procedure. Plain water is permissible up to 2 hours before the test.
  • Take all of your medications at the usual times prescribed by your doctor with sips of water.
  • You may wear something comfortable for the test. You will be asked to change into a hospital gown before the test.

How is the test performed?

  1. 1
    Before the test
  • Our cardiac technician will explain the procedure to you in detail, including the possible complications of the procedure and side effects. An opportunity will be given to you to ask questions.
  • You will be asked to change into a hospital gown before the test.
  • A small intravenous(IV) line will be inserted over your hand for administration of sedation. There will not be any General Anesthesia (GA) given for this procedure.
  • Three electrodes (small, flat, sticky patches) will be placed on your chest and connected to an electrocardiograph (ECG) monitor that charts your heart’s electrical activity.
  • A blood pressure cuff will be placed on your arm to monitor your blood pressure.
  • A small clip, attached to a pulse oximeter, will be placed on your finger to monitor the oxygen level of your blood.
  • A local anesthetic will be sprayed at the back of your throat to numb it.
  • You will be asked to lie on your left side on an exam table and the anesthetist will put medications into your IV to help you relax and you will start to feel drowsy at this point.
  1. 2
    During the test
  • The doctor will insert a thin, lubricated endoscope into your mouth, down your throat and into your esophagus. This part of the test lasts a few seconds and may be uncomfortable. The endoscope does not interfere with your breathing. You may be asked to swallow at certain times to help pass the endoscope.
  • Once the probe is in position, pictures of the heart are obtained at various angles (you will not feel this part of the test).
  • Your heart rate, blood pressure and oxygen level of your blood will be closely monitored during and immediately after the exam
  1. 3
    After the test
  • You will feel drowsy as the sedation wears off and we will keep you as comfortable as possible during this period.
  • Inform the cardiac technician if you feel uncomfortable at anytime after the test. It is common to feel a temporary soreness or numbness at the back of the throat after the test.
  • After you have recovered from the sedation given during the test, you may go home or go to your other scheduled appointments. Remember, you CANNOT drive yourself home after the test.
  • This test will take about 60-90mins.

How does the doctor use this test to treat me?

  1. 1
    Healthy exam
  • No further testing may be needed.
  1. 2
    Abnormal exam
  • Further investigations such as a cardiac computerized tomography (CT) scan or coronary angiogram may be needed.
  • Treatment with cardiac medications to optimize your condition may be given by our doctor.
  • Surgery may be needed to correct the structural abnormality eg severe valve disease.

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