Transesophageal echocardiography (TEE) is an examination that is performed to study the shape, structure and functioning of the heart (morphological and functional study).
It uses high-frequency sound waves (ultrasounds) produced by a probe placed in the esophagus and connected to an ultrasound, a machine capable of processing and representing images. The transesophageal probe, exploiting the close contact between the esophagus and the heart (the "esophagus is the tract of the digestive system that connects the mouth with the stomach passing behind the heart), allows a better visualization of the heart chambers, large pulmonary vessels and the aorta, heart valves, with better detail than allowed by the simpler transthoracic echocardiogram (ETT).The test
Before performing the examination, the doctor inquires about the results of previous tests concerning the esophagus and stomach, about any diseases present in these areas and about any pharmacological treatments in progress. In particular, it is important to tell your doctor if you are being treated with diabetes medicines, antiplatelet or anticoagulant drugs, if you have allergies and if you have difficulty swallowing.
To perform the transesophageal echocardiogram, it is necessary to fast from midnight before the day of the exam. Any medications can be taken by drinking only the amount of water needed to swallow them. If you have oral prostheses, they must be removed before undergoing the examination. Transesophageal echocardiography is neither painful nor dangerous, but passing the tube through the mouth may cause some discomfort. For this reason, just before inserting it, local anesthesia can be performed by spraying a spray (local anesthetic) into the mouth to reduce throat sensitivity and make the procedure more comfortable.
To perform the examination, the person is made to lie down on the bed on the left side, is connected to a monitor for continuous recording of the electrocardiogram and blood pressure and a small device, called oximeter, which allows the evaluation, moment by moment, of the level of oxygenation of the blood. In addition, a needle is inserted into the vein for the possible administration of drugs, if necessary. If the person is too anxious, they can be given a light sedation which, while keeping them awake, will reduce awareness of what is happening.
The transesophageal echocardiogram is very similar, from a technical point of view, to a gastroscopy. The doctor, after inserting a mouthpiece between the teeth in order not to damage the probe, introduces it in the mouth and guides it towards the esophagus proceeding gently. Passing the probe down the throat can be uncomfortable and cause a gag reflex or cough.
The duration of the exam depends on the reason for which it is performed and, above all, on the cooperation of the person. It usually lasts 10-15 minutes. At the end, usually no discomfort appears.
If a sedative has been administered, as the state of alertness may be reduced, it will not be possible to drive or carry out activities that require particular attention for at least 5-6 hours.
It is possible that there is an irritation of the throat, both due to the mechanical effect of the passage of the probe, and to the action of the local anesthetic. For this reason, it is not advisable to drink or eat 2-3 hours after the end of the exam.Results
The transesophageal echocardiogram (TEE) is used to ascertain (diagnose) and control some heart diseases such as, for example:
- coronary heart diseasealteration of the structure or functioning of the coronary arteries, the blood vessels that carry blood to the heart
- congenital heart disease, simple or complex malformations of the cardiovascular system present at birth
- myocardial infarction, a serious disease that occurs when the flow of blood to part of the heart suddenly stops
- aortic aneurysm, abnormal dilation of a part of the aorta, due to the collapse of its wall
- endocarditis, an inflammatory process affecting the endocardium, the membrane that lines the heart, which appears frequently in the course of various infections
- cardiomyopathy, heart disease that reduces your ability to contract
- heart valve disease, valve malfunction compromises the normal functioning of the entire heart
- injury to the heart or aorta, potentially life-threatening emergencies
- thrombi in the auricle of the left atrium, a small hollow structure in which blood clots can form that can cause a stroke or affect the treatment of atrial fibrillation, a type of arrhythmia
- study of the atrial septum, to check for defects
Transesophageal echocardiography (TEE) is a fairly safe investigation but, like all medical procedures, it can rarely cause some complications. Medicines used to relax the person undergoing the test, for example, can cause breathing problems. or nausea (feeling sick in the stomach), however these problems resolve without the need for any treatment. Your throat may remain slightly sore for a few hours after the test. Although rarely, the probe used during TEE can damage the esophagus by puncturing it with serious and often fatal consequences.Bibliography
National Institutes of Health (NIH). National Heart, Lung, and Blood Institute. Transesophageal Echocardiography (English)