What is a Transesophageal Echocardiogram (TEE)?
A Transesophageal Echocardiogram (TEE) is a specialized ultrasound that provides exceptionally clear and detailed images of your heart.
Unlike a standard echo (TTE), where the probe is on your chest, a TEE uses a small, flexible probe guided down your throat into the esophagus. Because the esophagus lies directly behind the heart, this technique bypasses obstructions like ribs and lungs, resulting in remarkably high-resolution pictures.
The Process: What to Expect
Preparation
You must have an empty stomach. You will be asked to not eat or drink for at least 6-8 hours beforehand. Because you will be sedated, you must also arrange for someone to drive you home.
The Procedure
- Prep: An IV line will be placed in your arm to give you a sedative to help you relax. Your throat will be numbed with a spray or gel to prevent gagging.
- Positioning: You will lie on your left side.
- Probe Insertion: The doctor will gently guide the thin probe into your mouth. You may be asked to swallow to help it go down. This part is brief and not painful, though it can be uncomfortable.
- Imaging: Once in place, the doctor will capture detailed images of your heart from many angles. The test usually takes 30-60 minutes.
Afterward, you'll rest until the sedative wears off. Your throat may be sore for a day. You cannot eat or drink for about an hour until the numbness is gone.
Why Is a TEE Needed? (Finding What a TTE Misses)
A TEE is ordered when a standard echo (TTE) doesn't provide enough detail. It is the best test for:
- Searching for Blood Clots: This is a primary use, especially to check a small pouch called the left atrial appendage. This is crucial before a procedure like cardioversion to prevent a stroke.
- Assessing Heart Valves: It provides superior images to check for leaky (regurgitation) or narrowed (stenosis) valves.
- Detecting Endocarditis: It is highly sensitive for finding infections (vegetations) on the heart valves.
- Evaluating the Aorta: It can clearly see the body's main artery to look for a tear (dissection) or bulge (aneurysm).
- Finding Holes in the Heart: It is used to find congenital problems like an Atrial Septal Defect (ASD) or Patent Foramen Ovale (PFO).
- Guiding Procedures: It is used *during* surgery to help surgeons repair heart valves.
How TEE Results Guide Treatment
The findings from a TEE often have an immediate and direct impact on your treatment plan.
- If a Blood Clot is Found: A planned cardioversion procedure will be cancelled. You will be started on blood thinners for several weeks to dissolve the clot.
- If Endocarditis (Infection) is Found: This confirms the diagnosis and leads to a long course of high-dose IV antibiotics, and possibly heart surgery.
- If a Severe Valve Problem is Found: The TEE provides the definitive evidence needed to refer you for valve repair or replacement surgery.
- If a Hole (ASD/PFO) is Found: The results are used to plan a minimally invasive catheter-based procedure to close the hole.
- If an Aortic Dissection is Found: This is a life-threatening emergency, and the TEE provides a rapid diagnosis so you can be taken for emergency surgery.