Robert Wood Johnson University Hospital

Transesophageal Echocardiogram

Transesophageal Echocardiogram

(TEE, Heart Scan with Endoscopy, Transesophageal Echocardiography)

Procedure overview

What is a transesophageal echocardiogram?

A transesophageal echocardiogram (TEE) is a diagnostic procedure that uses echocardiography to assess the heart’s function. Echocardiography is a procedure used to assess the heart's function and structures. During the procedure, a transducer (like a microphone) sends out ultrasonic sound waves at a frequency too high to be heard. When the transducer is placed on the chest at certain locations and angles, the ultrasonic sound waves move through the skin and other body tissues to the heart tissues, where the waves bounce or "echo" off of the heart structures. The transducer picks up the reflected waves and sends them to a computer. The computer displays the echoes as images of the heart walls and valves.

A transesophageal echocardiogram is performed by inserting a probe with a transducer down the esophagus rather than placing the transducer on the chest. The TEE transducer works in the same manner as the one described above.

By inserting the transducer in the esophagus, TEE provides a clearer image of the heart because the sound waves do not have to pass through skin, muscle, or bone tissue. For example, obesity or pulmonary disease (emphysema or chronic obstructive pulmonary disease, also known as COPD), may interfere with the ability to obtain adequate images of the heart when the transducer is placed on the chest wall.

Certain conditions of the heart, such as mitral valve disorders, blood clots or masses inside the heart, dissection (tear) of the lining of the aorta (the artery which carries oxygenated blood from the heart to the body), and implanted prosthetic (artificial) heart valves are better visualized and assessed with TEE.

TEE may be used during surgery to assess the cardiac status of patients with known cardiac disease who are undergoing noncardiac procedures, and during heart surgery to evaluate the effects of surgical intervention to the heart, such as bypass surgery or valve repair or replacement.

A TEE may utilize one or more of several special types of echocardiography, as listed below:

Other related procedures that may be used to assess the heart include resting or exercise electrocardiogram (ECG or EKG), stress echocardiogram, holter monitor, signal-averaged ECG, cardiac catheterization, chest X-ray, computed tomography (CT scan) of the chest, electrophysiological studies, magnetic resonance imaging (MRI) of the heart, myocardial perfusion scans, radionuclide angiography, and cardiac CT scans. Please see these procedures for additional information.

Reasons for the procedure

Transesophageal echocardiography may be performed to evaluate signs and symptoms that may suggest:

Additional reasons for which a TEE may be performed include, but are not limited to, the following:

There may be other reasons for your doctor to recommend a TEE.

Risks of the procedure

Possible risks associated with a transesophageal echocardiogram include, but are not limited to, the following:

Patients with known problems of the esophagus, such as esophageal varices, esophageal obstruction, or radiation therapy to the area of the esophagus should be evaluated carefully by the doctor before having the procedure.

Patients who are allergic to or sensitive to medications or latex should notify their doctor.

If you are pregnant or suspect that you may be pregnant, you should notify your doctor.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Before the procedure

During the procedure

A TEE may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor's practices.

Generally, a TEE follows this process:

  1. You will be asked to remove any jewelry or other objects that may interfere with the procedure. If you wear dentures or any oral prosthesis, they will be removed prior to the insertion of the TEE probe.
  2. If you are asked to remove clothing, you will be given a gown to wear.
  3. You will be asked to empty your bladder prior to the procedure.
  4. An intravenous (IV) line will be started in your hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed.
  5. You will lie on a table or bed, positioned on your left side. A pillow or wedge may be placed behind your back for support.
  6. You will be connected to an ECG monitor that records the electrical activity of the heart and monitors the heart during the procedure using small, adhesive electrodes. Your vital signs (heart rate, blood pressure, breathing rate, and oxygenation level) will be monitored during the procedure.
  7. A local anesthetic spray will be applied to the back of the throat. This will numb the back of your throat to make passing the TEE probe more comfortable.
  8. You will receive a sedative medication in your IV before the procedure to help you relax.
  9. If indicated, oxygen will be administered through nasal tubes.
  10. The room will be darkened so that the images on the echocardiogram monitor can be viewed by the doctor.
  11. The TEE probe will be passed through your mouth and down your throat. You may be asked to swallow to help pass the probe.
  12. Once the probe is in the right place, the images will be obtained.
  13. After the necessary images are obtained, the probe will be removed from your throat.

After the procedure

You will be moved to a recovery area, where nurses will monitor your heart rate, ECG, blood pressure, and oxygen levels.

When your gag reflex has returned, your vital signs are stable, and you are more alert, the ECG electrode pads, the oxygen probe, and the IV will be removed. You may dress.

You may feel weak, tired, or groggy for the remainder of the day of the procedure. You should feel normal by the day after the procedure. Your throat may be sore for a few days following the procedure due to the insertion of the TEE probe.

If the procedure was performed on an outpatient basis, you may be discharged home, unless your doctor determines that your condition requires further observation or hospital admission.

If you received sedation, you will need to have someone drive you home.

You may resume your usual diet and activities unless your doctor advises you differently.

Generally, there is no special type of care following a TEE. However, your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

Online resources

The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your doctor. Please consult your health care provider with any questions or concerns you may have regarding your condition.

This page contains links to other websites with information about this procedure and related health conditions. We hope you find these sites helpful, but please remember we do not control or endorse the information presented on these websites, nor do these sites endorse the information contained here.

American College of Cardiology

American Heart Association

National Heart, Lung, and Blood Institute (NHLBI)

National Institutes of Health (NIH)

National Library of Medicine


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