What is a transesophageal echocardiogram (TEE)?
A transesophageal echocardiogram (TEE) uses echocardiography to assess the structure
and function of the heart. During the procedure, a transducer (like a microphone)
sends out ultrasonic sound waves. When the transducer is placed at certain locations
and angles, the ultrasonic sound waves move through the skin and other body tissues
to the heart tissues. The waves bounce or echo off of the heart structures. The transducer
picks up the reflected waves and sends them to a computer. The computer displays the
echoes as images of the heart walls and valves.
A traditional echocardiogram (echo) is done by putting the transducer on the surface
of the chest. This is called a transthoracic echocardiogram. A TEE is done by inserting
a probe with a transducer down the esophagus. This provides a clearer image of the
heart because the sound waves don't have to pass through skin, muscle, or bone tissue.
The TEE probe is much closer to the heart since the esophagus and heart are right
next to each other. Being overweight or having certain lung diseases can interfere
with images of the heart when the transducer is placed on the chest wall. Certain
conditions of the heart are better seen with a TEE, such as mitral valve disorders,
blood clots or masses inside the heart, a tear of the lining of the aorta, and the
structure and function of artificial heart valves.
A TEE may use one or more of several special types of echocardiography, as listed
M-mode echocardiography. This is the simplest type of echocardiography. It makes an image that is similar to
a tracing rather than an actual picture of heart structures. An M-mode echo is useful
for measuring heart structures, such as the heart’s pumping chambers, the size of
the heart itself, and the thickness of the heart walls.
Doppler echocardiography. This Doppler technique is used to assess blood flow through the heart’s chambers and
valves. The amount of blood pumped out with each beat is an indication of the hearts
functioning. Doppler echocardiography can also detect abnormal blood flow within the
heart, which can mean there is a problem with one or more of the heart valves or with
the heart’s walls.
Color Doppler. This is an enhanced form of Doppler echocardiography. With a color Doppler, different
colors are used to designate the direction of blood flow. This simplifies the interpretation
of the Doppler technique.
2-D echocardiography. This technique is used to view the motion of the heart structures in real time. The
image made by a 2-D echo looks cone-shaped on the monitor. It shows the real-time
motion of the heart’s structures. This lets the healthcare provider see the various
heart structures at work and evaluate them using a single slice or 2-D image.
3-D echocardiography. This technique captures 3-D views of the heart structures with greater detail than a
2-D echo. The real-time images allow for a more accurate assessment of heart function
by using measurements taken while the heart is beating.
Why might I need a TEE?
A TEE may help assess symptoms that could suggest:
Atherosclerosis. This is a slow buildup of plaque in the large chest arteries, such as in the aorta
Cardiomyopathy. This is an enlargement of the heart due to thickening or weakening of the heart muscle.
Congenital heart disease. These defects occur during formation of the fetus' heart. A TEE can help assess and
locate the abnormality, as well as determine its effect on heart blood flow.
Heart failure. A condition in which the heart muscle has become weakened to an extent that blood
can’t be pumped efficiently. This can cause fluid buildup (congestion) in the blood
vessels and lungs, as well as the feet, ankles, and other parts of the body.
Aneurysm. This is a weakening and bulging of a part of the heart muscle or the large artery
that carries oxygenated blood out of the heart to the rest of the body (aorta).
Heart valve disease. Malfunction of one or more of the heart valves that may block blood flow within the
heart or result in blood leaking backwards (regurgitation).
Cardiac tumor. A tumor of the heart may occur on the outside surface of the heart, in 1 or more chambers
of the heart, or in the muscle tissue of the heart.
Pericarditis. This is an inflammation or infection of the sac that surrounds the heart.
Infective endocarditis. This is an infection of the heart, usually affecting the heart valves.
Aortic dissection. This is a tear in the wall of the aorta.
Blood clot and stroke. Blood clots can form inside the heart chambers, break free, and then flow to the
brain or other areas of the body. This can cause a stroke or other problems. Most
often these clots form with irregular heart rhythms or stagnant blood flow in the
Other reasons for a TEE include:
To evaluate the heart during open heart surgery after procedures, such as coronary
artery bypass or valve replacement or repair
To evaluate the heart during noncardiac surgery
Before cardioversion for atrial fibrillation or atrial flutter to make sure no clots
Your provider may have other reasons to recommend a TEE.
What are the risks of a TEE?
Possible risks of a TEE include:
You may not be able to have a TEE if you have problems of the esophagus, such as esophageal
varices, esophageal obstruction or stricture, radiation therapy to the area of the
esophagus, or any other past digestive problems. Your provider will evaluate you carefully
before having the procedure.
There may be other risks depending on your specific medical condition. Talk about
any concerns with your provider before the procedure.
How do I get ready for a TEE?
Your provider will explain the procedure to you and you can ask questions.
You'll be asked to sign a consent form that gives your permission to do the test.
Read the form carefully and ask questions if something isn't clear.
Follow any directions you're given for not eating or drinking before the procedure.
If you're pregnant or think you may be, tell your provider.
Tell your provider if you're allergic to or sensitive to medicines, local anesthesia,
Tell your provider about all prescription and over-the-counter medicines and herbal
supplements that you are taking.
Tell your provider if you have a history of bleeding disorders or if you're taking
any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect
blood clotting. You may be told to stop some of these medicines before the procedure.
Your provider may request a blood test before the procedure to determine how long
it takes your blood to clot. Other blood tests may be done as well.
Tell your provider if you have dental implants or dentures that should be removed
before the test
Tell the provider if you have heart valve disease, a congenital heart condition, or
a history of infection of the heart valves (endocarditis).
Based on your medical condition, your provider may request other specific preparation.
What happens during a TEE?
A TEE may be done on an outpatient basis or as part of your stay in a hospital. Procedures
may vary depending on your condition and your provider’s practices.
Generally, a TEE follows this process:
You'll be asked to remove any jewelry or other objects that may interfere with the
procedure. If you wear dentures or any oral prosthesis, they'll be removed before
the insertion of the TEE probe.
If you're asked to remove clothing, you'll be given a gown to wear.
You'll be asked to empty your bladder before the procedure.
An IV (intravenous) line will be started in your hand or arm to inject of medicine and
to give IV fluids, if needed.
You'll lie on a table or bed, positioned on your left side. A pillow or wedge may
be placed behind your back for support.
You'll be connected to an electrocardiogram (ECG) monitor that records the electrical
activity of the heart and monitors the heart during the procedure using small, adhesive
electrodes. Your heart rate, blood pressure, breathing rate, and oxygen level will
be monitored during the procedure.
A local anesthetic spray will be applied to the back of the throat. This will numb
the area to make passing the TEE probe more comfortable.
A bite protector will be placed in your mouth.
You'll receive medicine (a sedative) before the procedure to help you relax.
Oxygen will be given through tubes in your nose, if needed.
The room will be darkened so that the images on the echocardiogram monitor can be
seen by the provider.
The TEE probe will be passed through your mouth and down your throat. You may be asked
to swallow to help pass the probe.
Once the probe is in the right place, the images will be taken.
After the images are taken, the probe will be removed from your throat.
What happens after a TEE?
You'll be moved to a recovery area, where nurses will monitor your heart rate, ECG,
blood pressure, and oxygen levels.
When your gag reflex has returned, your vital signs are stable, and you are more alert,
the ECG electrode pads, oxygen probe, and IV line will be removed. You'll be able
to get dressed.
You may feel weak, tired, or groggy for the rest of the day. You should feel normal
by the day after the procedure. Your throat may be sore for a few days after the procedure
due to the insertion of the TEE probe.
If the procedure was done on an outpatient basis, you may be discharged home, unless
your provider decides that your condition requires further observation or hospital
You'll need to have someone drive you home.
You may resume your usual diet and activities, unless your provider tells you differently.
Generally, there special care isn't needed after a TEE. However, your provider may
give you other instructions after the procedure, depending on your situation.
Before you agree to the test or the procedure make sure you know:
The name of the test or procedure
The reason you're having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you're to have the test or procedure
Who will do the test or procedure and what that person’s qualifications are
What would happen if you didn't have the test or procedure
Any alternative tests or procedures to think about
When and how you'll get the results
Who to call after the test or procedure if you have questions or problems
How much you'll have to pay for the test or procedure