TEE is a diagnostic technique that allows doctors to obtain detailed images of the heart. It involves inserting a tube (probe) down the throat to reach the esophagus (windpipe). Generally, TEE is a safe procedure.

The technique utilizes sound waves to produce images of the heart. A doctor may order a TEE to collect more information than a standard echocardiogram can provide.

A doctor can advise on how best to prepare for the procedure. It may involve avoiding food and drink a few hours beforehand. Doctors usually sedate the patient during a TEE. After the test, people may expect to have a sore throat for a few days. A person should seek medical attention if the sore throat does not resolve.

This article reviews the use of TEE and what to expect before, during, and after the procedure. It also answers frequently asked questions about the procedure.

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TEE is a medical imaging procedure that looks at the heart and surrounding blood vessels. It uses ultrasound to take images of the heart and arteries.

However, unlike usual ultrasound techniques, which involve placing the probe on the outside of the body, TEE uses a thin tube inserted through the mouth. The probe used for TEE is called an echo transducer.

The doctor performing the TEE gently passes the tube down the throat and into the esophagus. The esophagus is located very close to the heart. The sound waves from the echo transducer in the esophagus produce detailed images of the heart.

Find out whether Medicare covers echocardiograms.

Doctors use the TEE when assessing for structural or functional issues with the heart. TEE provides detailed images of the inner workings of the heart, including the valves between the upper and lower chambers. While a standard echocardiogram also captures similar information, sometimes the images are unclear, or more details are required from a TEE.

Some of the features that TEE can provide in its images include:

  • size of the heart
  • the presence of blood clots
  • leaks in the heart chamber
  • atypical tissues in the chamber
  • infection of the heart valves (endocarditis)
  • valvular problems, such as stenosis of regurgitation

In real-time, the doctor can see how well the heart functions by watching each part of the beating heart.

Doctors may also perform TEE in advance of certain surgeries, such as heart valve repair.

Conditions TEE can help diagnose

TEEs are primarily used to look for blood clots, such as in cases of atrial fibrillation and when assessing valvular problems. Other indications for TEE include suspicion of endocarditis or a valve defect in people with valve replacements.

Another use of TEE is to find potential causes of strokes.

The TEE procedure tends to be safe and well-tolerated. However, it is not without risk. People can expect to experience some soreness of the throat and even a hoarse voice for a while.

Serious complications are rare. They can include injury or perforation of the esophagus, which can lead to bleeding. When experienced and trained doctors perform the TEE test, the risk of perforation is significantly lower.

Other risks associated with TEE include:

  • esophageal bleeding, such as from an esophageal tumor or varices (enlarged blood vessels related to cirrhosis)
  • spasm of the larynx or airways
  • arrhythmia (irregular heartbeat)

If healthcare professionals use sedation or anesthesia, there is a risk of other complications, such as:

  • breathing problems
  • aspiration
  • low blood pressure
  • medication reaction

Doctors or nurses can provide instructions on how to prepare for a TEE. Some clinics or hospitals may have slightly different protocols for preparing for the test. For example, some may suggest avoiding alcohol for a few days before the TEE.

Do not eat or drink 4–6 hours before the TEE to avoid complications during the test. The procedure requires giving people a sedative to help keep them calm. Doctors recommend not driving following a TEE, so people should make arrangements before the test to get home safely.

During the test, the patient lies on their back:

  1. First, a doctor sprays a numbing agent into the throat to help alleviate any discomfort.
  2. Then, the doctor attaches an IV line in the arm to administer a sedative, which helps keep people calm throughout the procedure.
  3. A healthcare professional attaches electrodes to the person’s chest in specific locations. These electrodes monitor the heart’s rhythm during the TEE.
  4. A healthcare professional inserts a tube into the throat, and the doctor may ask a person to swallow — this helps guide the tube down the esophagus.
  5. Once the tube is in place, the doctor takes images.

The person may find the procedure stressful because of the reflex to gag when anything is placed far enough into the mouth. However, the numbing agent and sedatives help lessen this sensation.

Once the exam is completed, the doctor removes the tube, IV line, and electrodes.

The TEE procedure usually takes about 30–60 minutes. Most of the time is spent preparing for the TEE. A nurse monitors the person once the procedure is over and the doctor has recorded the images. They watch over the person until they are fully awake and the effect of the sedative has worn off.

After the effect of the sedative wears off, the person can go home. A person cannot drive after a TEE, so they must plan to leave the hospital or clinic with another person.

Doctors will schedule a follow-up appointment to discuss the results.

Eating and drinking

The effect of the numbing agent sprayed into the throat at the start of the procedure may last until after the TEE is over. Doctors prohibit eating and drinking until the feeling of numbness disappears completely.

They advise avoiding hot liquids or foods due to the risk of burns after using numbing agents.

Also, the sedative doctors administer during the TEE may increase the side effects of alcohol. Doctors recommend avoiding alcohol for a day or two after the TEE.

Sore throat

People may complain of a sore throat after the TEE. This effect may be most noticeable within a few hours after the procedure. The sore throat may persist for a day or two.

Sometimes, a person’s voice may become hoarse for a few days due to tube insertion. Difficulty swallowing is another uncomfortable sensation after the TEE. However, after a few hours, this effect should disappear.

Serious complications of TEE can occur during the procedure. Fortunately, these complications are rare. A sign doctors will look for after a TEE is an injury to the esophagus. Esophageal perforation happens about 0.03% of the time. It is a rare but life threatening situation.

The most common effect after a TEE is a sore throat. If the sore throat does not resolve after a few days, the person should seek medical attention.

After a TEE, people should report if they experience any of the following:

  • bleeding
  • dizziness
  • lightheadedness
  • chest pain

Below are some commonly asked questions on the topic:

Are you awake during a transesophageal echocardiogram?

People are often in a “twilight” state of wakefulness after receiving a sedative for TEE, so they can still follow instructions for swallowing. However, in other cases, a person may receive general anesthesia and a breathing tube.

How serious is a TEE procedure?

Experts consider TEE to be a minimally invasive procedure. Generally, a TEE is well-tolerated and safe.

The TEE procedure does carry more risk than a standard transthoracic echocardiogram, as well as the risks associated with sedation.

A transesophageal echocardiogram is a minimally invasive medical imaging test. It requires inserting a tube with an echo transducer at the tip down the throat and into the esophagus. TEEs allow cardiologists to view the inside details of the heart to evaluate heart disease, infections, and the presence of blood clots.

Generally, a person receives sedation during the procedure. Although there may be some discomfort with inserting the tube (or probe), it should not be too painful. Straight after the TEE, a person may require monitoring to ensure that the effects of the sedation have worn off. The risk of serious complications tends to be lower if a well-trained and experienced doctor carries out the procedure.

People can expect a sore throat post-procedure, but this should clear up within a few days. It is best to speak with a doctor about any concerns before or after the procedure.