Transesophageal Echocardiogram (TEE)

Before the Procedure

Before a transesophageal echocardiogram (TEE), the following steps should be observed:

• The doctor will explain the procedure and offer the opportunity to ask any questions about the procedure
• Patients will be asked to sign a consent form that gives permission to do the test. Read the form carefully and ask questions if something is not clear
• Fasting prior to the procedure is required. The doctor will notify patients how long to fast, whether for a few hours or overnight
• If patients are pregnant or suspect they may be pregnant, patients should notify their doctor
• Notify the doctor if patients are allergic to or sensitive to medications, local anesthesia, or latex
• Notify the doctor of all medications (prescription and over-the-counter) and herbal supplements patients are taking
• Notify the doctor if patients have a history of bleeding disorders or if they are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary to stop some of these medications prior to the procedure
• The doctor may request a blood test prior to the procedure to determine how long it takes the blood to clot. Other blood tests may be done as well
• Notify the doctor if patients have heart valve disease, a congenital heart condition, or a history of endocarditis (infection of the heart valves) as patients may need to receive an antibiotic prior to the procedure
• Patients may receive a sedative prior to the procedure to help with relaxation. If a sedative is given, patients will need to arrange transportation after the procedure
  

Based upon certain medical conditions, the doctor may request other specific preparations.

During the Procedure

A transesophageal echocardiogram is performed by inserting a probe with a transducer down the esophagus rather than placing the transducer on the chest. 

Generally, a TEE follows this process:

1. Patients will be asked to remove any jewelry or other objects that may interfere with the procedure. If patients wear dentures or any oral prosthesis, they will be removed prior to the insertion of the TEE probe
2. If patients are asked to remove clothing, patients will be given a gown to wear.
3. Patients will be asked to empty their bladder prior to the procedure
4. An intravenous (IV) line will be started in the hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed
5. Patients will lie on a table or bed, positioned on their left side. A pillow or wedge may be placed behind the back for support
6. Patients 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. 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 the throat to make passing the TEE probe more comfortable
8. Patients will receive a sedative medication in IV before the procedure to help with relaxation
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 the mouth and down the throat. Patients 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 the throat

After the Procedure

After the esophageal echocardiogram, the following procedures and notes should be observed:

• Patients will be moved to a recovery area, where nurses will monitor the patient's heart rate, ECG, blood pressure, and oxygen levels
• When gag reflex has returned, vital signs are stable, and patients are more alert, the ECG electrode pads, the oxygen probe, and the IV will be removed and patients can get dressed
• Patients may feel weak, tired, or groggy for the remainder of the day of the procedure. Patients should feel normal by the day after the procedure. The 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, patients may be discharged home, unless the doctor determines that the condition requires further observation or hospital admission.
• If patients received sedation, they will need to have someone drive them home.
• Patients may resume their usual diet and activities unless the doctor advises differently.
• Generally, there is no special type of care following a TEE. However, the doctor may give patients additional or alternate instructions after the procedure, depending on the needs