Echocardiogram - transoesophageal

About transoesophageal echocardiogram

Transoesophageal echocardiogram uses sound waves (ultrasound) to check the structure of your heart and how well it's functioning. The procedure involves swallowing an ultrasound sensor to get pictures of your heart through the wall of your oesophagus. A transoesophageal echocardiogram gives more detailed pictures of the inside of your heart and the valves than a standard echocardiogram.

You may have a transoesophageal echocardiogram to check:

  • your heart valves or heart muscle
  • for any infection in your heart valves (endocarditis)
  • for any blood clots
  • for tears in your aorta (the largest blood vessel in your body)
  • for any heart defects, such as a hole in your heart

Transoesophageal echocardiogram can also be used to guide your surgeon during heart procedures, such as mitral valve surgery. You may also need to have it before a procedure known as atrial fibrillation ablation.

What are the alternatives to a transoesophageal echocardiogram?

Alternatives to having a transoesophageal echocardiogram include the following.

  • Echocardiogram. This involves moving an ultrasound sensor over your chest to get pictures of your heart. The procedure may be done if you find swallowing the sensor in a transoesophageal echocardiogram difficult. A special dye (contrast agent) may be used to show the structures of your heart more clearly, though it produces less detail than a transoesophageal procedure.
  • Cardiac MRI scan. MRI is a special technique that uses powerful magnets, radiowaves and computers to produce detailed images (or scans) of the inside of your heart.
  • Radionuclide test. This involves having an injection of a harmless, radioactive substance before a special camera is used to take pictures of your heart. The radioactive substance will show up as it travels through your heart and your doctor uses this to assess your heart function.

Your doctor will advise you which procedure is most suitable for you.

Preparing for transoesophageal echocardiogram

Transoesophageal echocardiogram is usually done as a day-case procedure in hospital. It’s usually performed by a cardiologist (a doctor specialising in conditions of the heart).

Your doctor will explain how to prepare for your procedure. For example, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. You should take any other medication as usual and let your doctor know if you’re taking anticoagulants (medicines that help to prevent your blood clotting) such as heparin, clopidogrel or warfarin.

You will usually stay awake during the procedure and have a sedative. This relieves anxiety and helps you to relax.

Your doctor will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during transoesophageal echocardiogram?

The procedure usually takes 15 to 20 minutes.

Your nurse will ask you to take off your shirt or top and put a hospital gown on. You will be asked to remove any dentures or dental plates, contact lenses, glasses and jewellery.

If you’re having a sedative, this is usually given through a fine tube (cannula) into a vein in your arm. Sedatives can sometimes affect your breathing, so your doctor will monitor the amount of oxygen in your blood during the procedure and may give you extra oxygen to breathe. Your heart rhythm will also be monitored throughout the procedure.

You will be asked to lie on your side with your head titled slightly forward. Your doctor will spray a local anaesthetic into the back of your throat and place a mouth guard over your teeth before putting the sensor in your mouth. He or she will then ask you to swallow to allow the sensor to pass into your oesophagus.

The sensor will send out sound waves and pick up the returning echoes. Pictures of the inside of your heart will be displayed on a screen. These pictures are constantly updated, so the scan can show movement.

Sometimes a contrast liquid may be injected into your vein during the test. This helps to show certain parts of your heart more clearly.

The test is painless but may feel uncomfortable when the sensor is passed into your oesophagus.

What to expect afterwards

You will need to rest until the effects of the sedative have passed. You should then be able to go home when you feel ready, but will need to arrange for someone to drive you home. If possible, try to have a friend or relative stay with you for the first 24 hours.

The results of your transoesophageal echocardiogram are usually sent to the doctor who requested your test. He or she will discuss the results with you at your next appointment.

Recovering from transoesophageal echocardiogram

After a local anaesthetic, it may take several hours before the feeling comes back into your mouth and throat. Don’t try to eat or drink until you can swallow normally. Once you’re able to swallow, start with fluids and then move onto food. But, don’t drink hot drinks until the effects of the local anaesthetic have fully worn off.

Sedation temporarily affects your coordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you’re in any doubt about driving, contact your motor insurer so that you’re aware of their recommendations, and always follow your doctor’s advice.

What are the risks?

As with every procedure, there are some risks associated with transoesophageal echocardiogram. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. For example, you may have a sore throat for a day or two.

Complications

Complications are when problems occur during or after the procedure. Specific complications of transoesophageal echocardiogram are uncommon, but can include:

  • damage to your teeth or dental work, such as crowns
  • damage or tear to your oesophagus
  • an allergic reaction to the sedative or contrast agent, such as a skin rash, difficulty breathing or heart problems

If you need more information, speak to your doctor.

What if I can’t swallow the sensor when I’m having a transoesophageal echocardiogram?

Answer

Before you have the procedure, your doctor will spray a local anaesthetic into the back of your throat. This helps to make it easier for you to swallow the sensor.

Explanation

The sensor is very thin and shouldn’t be difficult to swallow. The local anaesthetic will help stop your gagging reflex and your doctor will also give you a sedative into a vein to help you relax.

If you have any concerns about the procedure you should discuss these with your doctor before the test. You should tell your doctor before the test if you’ve had previous surgery to your throat or neck, any swallowing problems or if you’ve ever coughed up blood. Your doctor may suggest that you have an alternative test.

My doctor has recommended I have a transoesophageal echocardiogram. Why this and not a standard echocardiogram?

Answer

A transoesophageal echocardiogram produces more detailed pictures of your heart than a standard echocardiogram. This makes it more accurate for your doctor to diagnose any heart problems you may have. It's also much better for investigating artificial heart valves and looking for a blood clot in your heart.

Explanation

A routine echocardiogram is done by moving an ultrasound sensor over your chest. Although it produces good pictures of your heart, the sound waves have to pass through your skin, fat, bone, tissue and air of your ribcage and lungs. This means that the pictures aren't as clear as in a transoesophageal echocardiogram, where the sensor is placed very close to the back of your heart.

How will my doctor know if there is a problem with my heart?

Answer

A transoesophageal echocardiogram produces detailed pictures of the structures inside your heart, which allows your doctor to identify any problems.

Explanation

To check for heart valve disease, your doctor will look at the shape of your valves, how they are moving and for signs of calcium deposits. By measuring how fast your blood is flowing, your doctor will be able to see whether your valves have become narrow or are leaking.

If you have an infection of your heart valves, the transoesophageal echocardiogram may show this. To check how well your heart is pumping blood, your doctor will look at the size, thickness and function of your left ventricle. This is one of the lower chambers of your heart, which pumps blood that contains oxygen around your body. Looking at the size of your left ventricle and how well it’s working can show your doctor whether there is a problem with your heart’s pumping ability.

What will happen after I get the results of my transoesophageal echocardiogram?

Answer

Your doctor will help you to choose the best course of action or treatment, based on the results of your transoesophageal echocardiogram, together with any other tests you’ve had done. Depending on the results, you may need to have treatment such as medicines or surgery.

Explanation

A transoesophageal echocardiogram is just one test that doctors use to assess how your heart is working. You may have other tests such as an electrocardiogram (ECG), a chest X-ray, blood and urine tests.

Your doctor may diagnose a problem with your heart using the results of all these tests. However, your transoesophageal echocardiogram may also rule out a problem with your heart, or show that you need further tests before a diagnosis can be made.

If tests do show up a problem with your heart, your doctor will discuss your treatment options with you. Depending on the problem identified, you may be advised to take medicine or have surgery.