Transesophageal echocardiography is a diagnostic test using an ultrasound probe that is passed into the esophagus (food tube) of the patient.  Since the esophagus is right behind the heart, transesophageal echocardiography provides a very clear picture of the heart and it is especially useful when small details of heart valves and chambers need to be evaluated.  It can detect abnormal tissue growth on the heart valves, blockage or leakage of the heart valves, known as stenosis or regurgitation and abnormal blood clots inside the heart.

How to prepare for the procedure

Patients should avoid consuming alcohol for a day or so before the procedure, since alcohol may amplify the effects of the sedative used with the procedure.  The doctor will also instruct you not to eat or drink anything before the procedure.

What to expect during the procedure

A transesophageal echocardiography examination generally lasts 30-60 minutes. The nurse will place an i.v. catheter to be able to give patient medications during the procedure.  The patient is given a mild sedative and the back of the throat is sprayed with a local anesthetic, in order to suppress the gag reflex.  If the patient has dentures or partials the nurse will ask the patient to remove them.  The patient will receive a plastic teeth protector to be placed between teeth.  Next, a special viewing tube is passed through the mouth and into the esophagus. It is carefully moved until it is positioned directly next to the heart.  The images are displayed on a monitor and recorded on tape and in the computer. The tube may be moved several times during the test to help doctors get a better view of the heart.  The tube is removed at the end of the procedure.

Aftercare

After the test, it is important to refrain from eating or drinking until the gag reflex has returned--otherwise, the patient may accidentally inhale some of the food or beverage (aspirate). If a sedative has been given, patients should not drive or operate heavy machinery for the rest of the day. They should avoid consuming alcohol for a day or so, since alcohol may amplify the effect of the sedative.

Risks

Transesophageal echocardiography may cause gagging and discomfort when the ultrasound probe is passed down into the throat. Patients may also experience sore throat for a few days after the test. The patient may have an adverse reaction to the sedative or local anesthetic.  Other rare complications include aspiration pneumonia, heart rhythm problems and damage to teeth.  In very rare cases, the procedure may cause bleeding or perforation of the esophagus.

Key Terms

Gag reflex - a normal reflex consisting of elevation of the palate, retraction of the tongue, and contraction of the throat muscles.

Regurgitation - backward flow of blood through a partly closed valve.

Transducer/ultrasound probe - a device that converts electrical signals into ultrasound waves and ultrasound waves back into electrical impulses.

Ultrasound - sound waves at a frequency of 20,000 kHz, often used for diagnostic imaging.