Transesophageal Echocardiogram - Indications, Procedure, and Risks

Introduction

An echo, echocardiogram, cardiac echo, or echocardiography is referred to as the Doppler ultrasound of the cardiovascular structures, especially the heart. An echocardiogram is one of the most common and widely suggested cardiovascular imaging tests. An echocardiogram aids the healthcare provider in having a deep look into the blood vessels as well. The tip of the echocardiogram sends waves that reflect back after bouncing on the surface of the organ. A TEE or transesophageal echocardiogram is a substitute for performing a routine echocardiogram. A particular variety of probes that includes an ultrasound device at its end is used during a transesophageal echocardiogram. This specialized tip is passed down the esophagus (food pipe) of the patient. With the help of a transesophageal echocardiogram, a Doppler study can additionally be recorded. Thus, a transesophageal echocardiogram helps in producing the outline of the cardiac structures and hence leads to clear-cut diagnosis and better treatment and management strategies for the healthcare professional and team.

When Is Transesophageal Echocardiogram Suggested?

A transesophageal echocardiogram is a special and unique kind of echocardiogram that is not suggested in routine cardiovascular consultations. This ultrasound of the heart aids the healthcare provider in a deeper and more precise understanding of the condition of the cardiovascular system. A transesophageal echocardiogram is suggested when a severe condition of the heart or related structures is suspected. In case healthcare professionals want to study the patient's cardiovascular system for a more definite and accurate diagnosis, the transesophageal echocardiogram is advised. Mentioned below are a few of the cardiac conditions when the patient is asked to go for a transesophageal echocardiogram.

• Evaluation of heart valves.

• Locating blood clots.

• Treatment for the abnormal rhythm of the heart.

• Before cardioversion.

• Produce a moving image of the heart.

• Atherosclerosis.

• Cardiomyopathy.

• Heart failure.

• Cardiac aneurysm (bulge or weakened area in the wall of the heart that can disrupt normal blood flow).

• Valvular heart failure.

• Rheumatic heart disease.

• Tumor lesions in the cardiovascular system.

• Pericarditis (inflammation of the protective sac surrounding the heart).

• Aortic dissection.

• Evaluation of stroke.

• Congenital heart disorder.

• To study the arteries of the heart.

• Pericardiocentesis (a procedure in which fluid is drained from the pericardium using a needle).

• Myocardial infarction.

• Before placing an inferior vena cava filter.

• Cardiac tamponade (a condition where fluid accumulates in the pericardium).

• Cardiogenic pulmonary edema.

• Foreign body.

Does Transesophageal Echocardiography Pose Any Risk?

There is no medical procedure, especially a procedure or a diagnostic test related to the cardiovascular system, that does not pose a certain amount of risk to the patient. The same applies to transesophageal echocardiography. Patients who have a known anomaly with the esophagus- esophageal varices, obstruction of the esophagus, esophageal stricture, and radiation or chemotherapy in the area around the esophagus are not supposed to go ahead with transesophageal echocardiography. Such patients are thoroughly evaluated by the respective healthcare provider before going ahead with transesophageal or any other kind of diagnostic tool that may be associated with the esophagus. In addition to this, the patient must inform the healthcare provider of any type of underlying medical anomaly that they may be suffering from. Mentioned below are a few of the risks posed by transesophageal echocardiography.

• Difficulty while breathing.

• Abnormal rhythms of the heart.

• Bleeding in the site of transesophageal echocardiography.

• Harm to the teeth.

• Injury to the soft tissues - lips, cheek, tongue.

• Development of sore throat.

What Happens During a Transesophageal Echocardiogram?

Transesophageal echocardiography, or a TEE, is in a scheduled setup. There may be a slight difference in the approach of transesophageal echocardiography as per the healthcare provider. Mentioned below are the steps that occur during a transesophageal echocardiogram.

• All the metal items, such as jewelry and related ornaments, must be removed before the procedure.

• The patient is requested to wear a gown that will help the healthcare provider and tram to perform the echocardiography with ease.

• The patient must make sure their bladder is empty before the procedure begins.

• An intravenous line is placed through the arm of the patient to make sure there is an ample supply of fluids and necessary elements.

• The patient is asked to lie flat or either toward the left side of the bed.

• All the vital signs of the patient are monitored throughout the procedure, such as breathing rate, blood pressure, heart rate, oxygen saturation, and so on.

• The electrical changes and activities of the heart are monitored and evaluated through an electrode that is attached to the echocardiography machine from one end and placed on the patient's chest from the other end.

• The throat of the patient is made numb by the application of local anesthesia or by spraying local anesthesia so that there is minimal discomfort to the patient.

• At times, patients who are very anxious may need to be injected with sedatives so that they may relax throughout the procedure. The healthcare provider will be the best person to decide if there is a need for sedation or not.

• Oxygen is administered through nasal tubes.

• The room is not lit and is kept dark for better visualization of the images being reflected through the echocardiography.

• The transesophageal tube is then passed down, and the patient may be asked to swallow for better insertion of the tube.

• Images are recorded once the tube reaches the desired location.

• Once done, the tube is carefully removed, and the patient is monitored for a while.

Conclusion

Echocardiography, or an echo, is a cardiovascular procedure where the patient undergoes a series of radiographic imaging so that the healthcare provider is able to assess the condition of the patient's heart. Transesophageal echocardiography is a variant of the standard echocardiography wherein a specialized flexible tube with a camera at its tip is passed down the food pipe, called the esophagus, of the patient. This procedure aids the healthcare specialist in a better view and deeper understanding of the patient's cardiovascular condition. The information is much more in detail and in-depth as compared to regular echocardiography. The transesophageal echocardiography test will take about 90 minutes to be completed. After the tests, the results are discussed with the patient, and depending on those, the patient may be suggested additional tests or may be informed about their line of treatment.