The Transesophageal Echocardiogram (TEE)

echocardiogram
Echocardiogram. Darryl Torckler/Getty Images

An echocardiogram is a type of study that uses high-frequency sound waves to produce a real-time, moving image of the beating heart. Echocardiography is an excellent way for a cardiologist to “visualize” the overall function of the heart, and to assess critical portions of the heart’s anatomy. 

Standard, non-invasive echocardiograms can be performed in a doctor’s office, or at the bedside in people who are hospitalized, with little or no preparation, and in most cases they are fine for gaining the desired information about a person’s heart. But sometimes standard echocardiography does not produce adequate images, or perhaps more precise anatomical information is needed than can be acquired using the standard procedure. 

In these cases, a transesophageal echocardiogram (TEE) can often be employed. Like standard echocardiography, the TEE uses sound waves to produce an 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). Because the esophagus passes directly behind the heart, the images that can be obtained with a transesophageal echocardiogram are extremely clear and detailed. So using a TEE instead of a standard echocardiogram can be very useful under the right circumstances.

How Is TEE Performed?

The major difference between a standard echocardiogram and a TEE is that with a TEE, the transducer used to generate sound waves has to be passed into your esophagus using a soft tube. In other words, the TEE is considered to be an invasive study.

The preparation for a TEE is similar to that for an [upper GI endoscopy[(https://www.verywellhealth.com/upper-endoscopy-p3–1324181). You will have to fast for 12 hours prior to the test. You will be brought into a laboratory (or an operating room if the test is being done during surgery). You will then 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.

Advantages of a TEE

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 several circumstances in which a TEE may be recommended over a standard echocardiogram.

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, highly detailed echo images are obtainable in virtually anybody.

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.

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.

A TEE is also very useful in evaluating a suspected aortic dissection and other conditions affecting the aorta, since the esophagus and the aorta are directly adjacent to one another.

Complications With TEE

The most common problem with the TEE is a certain amount of gagging and throat discomfort during the procedure. However, it is usually easy for the doctor 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 happen with a TEE. However, these serious adverse events are extremely uncommon.

A Word From Verywell

Transesophageal echocardiography (TEE) is an excellent method for visualizing critical structures of the beating heart. In cases where a standard echocardiogram does not produce adequate images, or when extremely detailed cardiac images are critical to providing optimal care, a TEE can be very useful.

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Article Sources

  • Hahn RT, Abraham T, Adams MS, et al. Guidelines For Performing A Comprehensive Transesophageal Echocardiographic Examination: Recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr 2013; 26:921.

  • 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