Transesophageal Echocardiogram (TEE)

What is a TEE?

A TEE uses an echocardiogram (ultrasound) and a probe (a long flexible tube) to examine hard-to-see structures of the heart from the inside of the esophagus (the tube leading from the mouth to the stomach). The esophagus lies just behind the heart so a TEE gives much sharper and clearer images of the heart than a standard echocardiogram. The probe is about the width of your little finger and is inserted into the mouth and down the esophagus to the stomach. A transducer is at the tip of the probe. The transducer sends ultrasound waves that echo, or reflect, off parts of the heart. The echoes are converted into moving images of the heart. The images show the actual shape and movement of the heart structures, and blood flow through the heart and valves. The images are displayed on a screen and recorded on videotape.

How do I prepare for the test?

• Do not eat or drink anything for 6 hours before the procedure this includes taking your medications. If you take oral medications, talk to your doctor about your medication schedule during your test day.
• If you are an outpatient, have someone pick you up after your procedure. Do not drive yourself home because you may be drowsy.
• Tell the doctor or nurse if you have problems swallowing or have any conditions involving the esophagus or stomach.
• Tell the doctor or nurse if you have any allergies to medications or equipment (such as latex or iodine).
• Bring a list of all medications you are currently taking.
• Ask questions or share your concerns before the test.
• If you wear dentures or oral prostheses, you will need to remove them.

What happens during the test?

The TEE is usually performed as an outpatient. You should arrive 2 hours before your test. After you go through admitting, you will go to the third floor (3 South) - Outpatient Care. You will change into a hospital gown. An intravenous line (IV) will be started in a vein in your arm. You will be transported to the second floor cardiology unit. Once in the testing room, you will be asked to lie on your left side. Your throat may be sprayed with an anesthetic to numb it. You will also be given a low dose of a sedative through the IV line in your arm, to help you relax.

The Cardiologist inserts the probe into your mouth. As you swallow, the probe is directed into the esophagus. You may gag when the probe first enters the esophagus, and you may feel the probe moving, but the procedure is generally not painful and patients often do not remember the procedure.

The transducer is positioned in the esophagus where it picks up high quality images of the heart. The Cardiologist uses control knobs to move the tip of the probe to view the heart from different angles. While the Cardiologist and Echo Tech are obtaining the images, the Nurse monitors your vital signs (blood pressure, heart rate, oxygen level) and suctions your mouth as needed. You may also be given oxygen.

You will be returned to the Outpatient Care unit. The IV will be discontinued and you will be discharged from there. The Cardiologist conducting the test may be able to give you preliminary test results before you leave. Or, your own doctor will discuss the test results during and office visit.

Why is the TEE done?

• To detect blood clots or masses inside the heart
• To detect infection of the heart valves
• To examine a prosthetic heart valve
• To assess the severity of some valve defects
• To diagnose a dissection (a tear) in the lining of the aorta (the body's main artery)
• To evaluate holes between heart chambers
• When the standard echocardiogram quality is poor or inadequate (such as in people who are obese or have a lung condition)

What should I do after the test?

• Do not eat or drink for about an hour or so after the TEE, until your throat is no longer numb.
• Have someone drive you home. Do not drive for 12 hours.
• Report any unusual symptoms such as chest pain, bleeding, fever, infection, difficulty swallowing, shortness of breath.
• If your throat feels sore you should soothe it with cold drinks and lozenges (once the hour has past).

Is the TEE safe?

The doctor will review the risks of the procedure. The TEE is considered to be a relatively safe procedure but there are risks involved because a probe is inserted into the body. Possible risks include: breathing problems, infection, reaction to the sedatives/medications used, bleeding, abnormal heart rhythms. Rarely does the TEE pierce or damage the esophagus.

Where is the test performed?

On the second floor of Sparrow Hospital in the cardiology department Heart Center.

How long does this test take?

The actual TEE probe time takes between 15 and 20 minutes. You should allow one and a half hours for the entire test as you will need to recover from the conscious sedation. Give yourself 5 hours from your arrival time to the time you can leave.