How to Perform a Transesophageal Echocardiogram

A transesophageal echocardiogram (TEE) is a diagnostic procedure used to capture detailed images of the heart by inserting an ultrasound probe through the esophagus. This method allows for clearer visualization of cardiac structures by avoiding interference from the lungs and chest wall. Below is a step-by-step guide to performing the procedure effectively and safely.

Preparation Before the Procedure

Before starting the TEE, it is crucial to ensure that the patient is properly prepared. Patients are typically required to fast for at least 4 to 6 hours prior to the exam to reduce the risk of aspiration. Additionally, the medical team must verify whether the patient has any allergies—especially to local anesthetics—wears dentures, or has a history of infectious diseases. These factors are essential in minimizing complications and ensuring patient safety.

Administering Local Anesthesia

Begin by applying a local anesthetic such as lidocaine or tetracaine hydrochloride to numb the patient's throat. This helps suppress the gag reflex and makes the insertion of the probe more comfortable. The patient should be positioned on their left side and instructed to bite down gently on a mouth guard. They should also be reminded not to swallow saliva during the procedure to prevent potential injury to the throat from the probe.

Inserting the Probe

Next, connect the transesophageal ultrasound probe and apply a sterile lubricant. Carefully insert the probe through the mouth while monitoring the patient's comfort level. As the probe reaches the back of the throat, ask the patient to swallow, which helps ease the passage into the esophagus. Once in place, adjust the depth and angle of the probe to capture high-quality images of the heart from various perspectives. This step is essential for obtaining a comprehensive assessment of cardiac function and anatomy.

Post-Procedure Care

After the examination, patients should refrain from eating or drinking for at least two hours to allow the anesthetic to wear off completely. It is recommended that they consume soft or semi-liquid foods for the remainder of the day. While TEE offers superior imaging by eliminating lung interference and providing clearer views of abnormalities, it does have limitations. Specifically, the range of imaging angles is narrower compared to transthoracic echocardiography (TTE), which provides a more comprehensive view of the heart.

Advantages and Limitations

Advantages of TEE include its ability to detect small structural abnormalities, such as blood clots or valve damage, with high precision. It is especially useful in emergency and surgical settings where immediate and accurate diagnosis is critical. On the other hand, the limitations of TEE involve its invasive nature and the fact that not all cardiac structures are as easily visualized as they are with TTE. Therefore, the decision to perform TEE should be based on the patient's specific clinical needs and the diagnostic goals of the physician.