What is transesophageal echocardiography (TEE) test?

/ Dr. Nitin Parashar

Transesophageal Echocardiography (TEE) is a diagnostic procedure used to obtain detailed images of the heart.

  1. What is TEE?
    • TEE involves using high-frequency sound waves (ultrasound) to create pictures of your heart and the arteries connected to it.
    • Unlike a standard echocardiogram, where the transducer is placed on the chest, TEE uses a specialized probe attached to a thin tube.
    • This tube is inserted through your mouth, down your throat, and into your esophagus (the tube connecting your mouth to your stomach).
    • Because the esophagus is close to the upper chambers of the heart, TEE provides clearer images of these heart structures and valves.
  2. Why is TEE Performed?
    • Doctors use TEE to:
      • Evaluate heart structure and function: TEE provides clearer images of the heart’s size, wall thickness, and pumping ability.
      • Detect heart problems: It helps identify issues such as abnormal tissue around heart valves (indicating infections or cancer), defects causing heart murmurs, and blood leakage through heart valves.
      • Assess blood clots: TEE can reveal blood clots in the heart chambers, especially in conditions like atrial fibrillation.
      • Guide treatment decisions: TEE assists during heart surgery, repair of heart valves, and treatment for endocarditis (bacterial infection of the heart lining).
  3. Risks of TEE:
    • The procedure involves passing the probe through your mouth and throat.
    • You’ll receive medications to calm you and numb your throat, but you may still feel like gagging.
    • Common side effects include a sore throat for a day or two.
    • Rarely, there may be an allergic reaction to medications or minor bleeding in the esophagus.
  4. Preparation for TEE:
    • Check with your healthcare provider for specific instructions.
    • You may need to avoid alcoholic drinks and fasting before the test.
    • Since you’ll receive a sedative, arrange for someone to drive you home afterward.

Remember, TEE is a valuable tool for diagnosing heart conditions and guiding treatment decisions. Always follow your doctor’s recommendations regarding this procedure.

How long does the TEE test take?

The duration of a Transesophageal Echocardiography (TEE) test typically varies, but here are some general guidelines:

  1. Preparation:
    • Before the procedure, you’ll be asked to fast for a few hours.
    • You’ll receive a sedative to help you relax.
    • The entire preparation process usually takes about 30 minutes.
  2. During the Procedure:
    • The actual TEE procedure takes approximately 15 to 30 minutes.
    • You’ll lie on your left side, and a specialized probe will be inserted through your mouth and into your esophagus.
    • The doctor will guide the probe to obtain detailed images of your heart.
  3. Recovery:
    • After the test, you’ll be monitored for a short period.
    • The sedative effects may take a few hours to wear off.
    • Overall, the recovery time is usually around 1 to 2 hours.
  4. Total Time:
    • From preparation to recovery, the entire TEE process typically lasts about 2 to 3 hours.

Remember that individual experiences may vary, and your healthcare provider will provide specific instructions based on your situation. If you have any concerns or questions, feel free to discuss them with your doctor.

What is the difference between a standard echocardiogram and TEE?

Let’s understand the differences between a standard echocardiogram and Transesophageal Echocardiography (TEE):

  1. Method of Imaging:
    • Standard Echocardiogram:
      • Also known as a transthoracic echocardiogram (TTE).
      • The transducer (ultrasound probe) is placed on the chest.
      • Images are obtained through the chest wall, providing a view of the heart from the outside.
    • TEE:
      • Involves inserting a specialized probe into the esophagus (the tube connecting the mouth to the stomach).
      • The esophagus is close to the upper chambers of the heart, allowing for clearer images of specific heart structures.
  2. Image Quality:
    • Standard Echocardiogram:
      • Provides good overall views of the heart.
      • Limited by the chest wall and ribs, which can sometimes obscure certain areas.
    • TEE:
      • Offers higher resolution and better visualization of specific heart structures (such as heart valves, atria, and aorta).
      • Particularly useful for assessing blood flow, detecting clots, and evaluating heart valve function.
  3. Clinical Indications:
    • Standard Echocardiogram:
      • Commonly used for routine heart assessments, detecting heart murmurs, and evaluating heart function.
    • TEE:
      • Reserved for specific situations, such as:
        • Assessing valve function during surgery or interventions.
        • Detecting blood clots in the heart (especially in conditions like atrial fibrillation).
        • Evaluating endocarditis (bacterial infection of the heart lining).
  4. Procedure and Patient Experience:
    • Standard Echocardiogram:
      • Non-invasive and painless.
      • Transducer placed on the chest; no sedation required.
    • TEE:
      • Involves passing a probe through the mouth and throat.
      • Requires sedation to minimize discomfort.
      • May cause a sore throat afterward.
  5. Guidance for Treatment:
    • Standard Echocardiogram:
      • Provides essential information for general heart health.
    • TEE:
      • Assists in guiding treatment decisions during heart surgery, valve repair, and other interventions.

In summary, while both techniques provide valuable information, TEE offers more detailed views of specific heart structures and is particularly useful in specific clinical scenarios.

You can know more about TTE here (Transthoracic Echocardiogram).

What are some risks of a TEE test?

When it comes to a Transesophageal Echocardiography (TEE) test, there are minimal risks involved. Here’s what you need to know:

  1. Possible Risks:
    • Damage to the Esophagus: Although very rare, there is a risk of bleeding or a tear in the esophagus during the procedure.
    • Reaction to Medication: Some patients may experience reactions to the medications used to relax them during the TEE. These reactions could include nausea and difficulty breathing.
    • Sore Throat: After the procedure, it’s common to have a sore throat for a day or two.
  2. Precautions:
    • To minimize these risks, inform your doctor if you:
      • Have any allergies or sensitivities to medications.
      • Experience discomfort during the procedure (they can take steps to ease it).
      • Wear dentures or false teeth (you’ll need to remove them before the procedure).

Remember that the overall risks associated with TEE are quite low, and the benefits often outweigh them. 

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