The Transesophageal Echocardiogram (TEE)

Echocardiogram. Darryl Torckler/Getty Images

The transesophageal echocardiogram (TEE) is a test used to assess the structure and function of your heart. Like a standard echocardiogram, the TEE uses high-frequency sound waves to produce a real-time, moving image of the beating heart. However, while standard echocardiography is performed by placing the sound wave transducer over your chest wall, with a TEE the transducer is passed into the esophagus (your swallowing tube). 

The TEE can generate very clear cardiac images, and using a TEE instead of a standard echocardiogram can be extremely useful under the right circumstances.

How Is TEE Performed?

If you have a TEE you will first be given a mild intravenous sedative, and your gag reflex will be suppressed by spraying a local anesthetic into the back of your throat. The echo transducer will then be passed through your mouth and throat, and down your esophagus until it is positioned directly behind your heart.

Once in position, the transducer is used to bounce sound waves off your heart, just as in the standard echocardiogram. The returning sound waves are processed into a moving image of your heart and projected onto a computer screen for analysis.


The real advantage of a TEE is that it can usually generate much more detailed cardiac images than a standard echocardiogram. This is because the echo image is made from directly behind the heart — the sound waves don’t need to penetrate the rib cage and lung tissue before reaching the heart.

When Is A TEE Useful?

There are generally three circumstances in which a TEE may be recommended over a standard echocardiogram.

First, a TEE is useful whenever adequate echo images cannot be obtained by the standard echo techniques. This may occur in people whose chest walls are particularly thick, or who have emphysema, or recent chest trauma or chest surgery. Sometimes it is just difficult to get a clear image with a standard echo for no obvious reason. With a TEE, good echo images are obtainable in virtually anybody.

Second, TEE can be performed in the operating room during open heart surgery. Intraoperative TEE is especially useful during heart valve surgery, especially when performing a valve repair to treat mitral regurgitation. The TEE can give instant feedback to the surgeon as the repair is being performed.

Third, the TEE can be quite useful in assessing whether a patient developed blood clots in the left atrium. For instance, demonstrating by TEE that no blood clots are present can make cardioversion of atrial fibrillation significantly safer.


The most common problem with the TEE is a certain amount of gagging and throat discomfort during the procedure. However, it is usually easy to control these symptoms with sedation and numbing of the throat. You may have a sore throat for a few days after the procedure. Rarely, perforation of the esophagus can occur, which is a surgical emergency, and occasionally bleeding from the esophagus can be seen. However, these serious adverse events are extremely uncommon, and TEE is considered to be quite safe.

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Article Sources
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  • American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, et al. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance Endorsed by the American College of Chest Physicians. J Am Coll Cardiol 2011; 57:1126.v