trans-esophageal echo (TEE) : WHAT TO EXPECT
In principle, a transesophageal echocardiogram, commonly known as a "TEE" is actually the same as a regular echocardiogram. The main difference is the location from where the images are acquired. In a regular echocardiogram, a sonographer will place the echocardiography probe on your chest and capture images of your heart. Unfortunately, a traditional echocardiogram is not always best suited for evaluating the chambers of your heart, or looking at your heart valves very closely. This is because the normal ultrasound beam has to traverse a lot of layers of tissue, skin, and bone as it travels from the outside of the chest wall, before it can reach the heart. To circumvent this problem, a transesophageal echocardiogram was invented. This technique takes advantage of the geographic proximity of the heart to the food pipe or esophagus. Because the esophagus is located directly behind the heart, if the probe is inserted through the esophagus, there is very little loss of quality in the image, and the resolution and accuracy of echocardiography images are pristine.
Because of this, if your doctor indicates to you that are transesophageal echocardiogram or TEE is required, the are usually looking for small structural detail in the heart such as blood clots, little growths on the surface of the heart valves, and sometimes intricate details of the valves themselves. This is particularly true when patients develop either valvular heart disease causing valve leaks of our blockages.
Because the TEE probe is inserted from the mouth and placed in the esophagus, it typically cannot be done while the patient is awake. This means you will likely receive sedation during the procedure. On the day of the procedure, you will be has to come to the hospital on an empty stomach, and before the procedure begins your doctor will go over all the important details. This includes verifying that you have no breathing problems, no prior surgery in your esophagus, or throat, no history of intubation problems, or reaction to any of the medications you will receive for sedation. Once this checklist is complete, you will receive a spray the back of your throat that numbs your pharynx and diminishes your gag reflex. You may also be asked to swallow a substance that is thick and goopy (viscous lidocaine) to further help with numbing the back of your throat. Once this is done, your doctor will order the administration of IV sedation which will make you feel very sleepy. Once you become very comfortable, the TEE probe will be gradually introduced through your mouth, and once it reaches the back of your throat, you will be asked to swallow. This is a very important step, because cooperation during swallowing, will help the probe slide past the epiglottis, and your esophageal sphincter and make its way where it can begin capturing pictures of your heart.
The actual procedure is expected to take anywhere from 15 to 20 minutes not including time for sedation and recovery. Most patients typically go home the same day after the sedation has worn off. It is important that you bring a family member with you to take you home since patients are not in a position to drive themselves after receiving sedation.
WHAT HAPPENS NEXT?
After the TEE is complete, you will remain in the recovery area for a few hours, whereas sedation trained nurse will monitor you during recovery. He or she will be ensuring that your heart rate, and blood pressure remains normal, and that you gradually recovered to the point where you can return home safely. Obviously if there is any problem, the doctor will be notified. As mentioned above, nearly all patients go home the same day unless there is some unexpected complication.
After your doctor has had an opportunity to review the images, he will let you know of the results, either directly or via a phone call. Typically since the physician performs the procedure himself, all of our patients get the result immediately after the procedure.