For more information, visit http://www.nhlbi.nih.gov/health/health-topics/topics/tee/

Types of Transesophageal Echocardiography

Standard transesophageal echocardiography (TEE) pictures are two-dimensional (2D). It's also possible to get three-dimensional (3D) pictures from TEE. These pictures provide even more details about the structure and function of the heart and its blood vessels.

Doctors can use 3D TEE to help diagnose heart problems, such as congenital heart disease and heart valve disease. Doctors also may use this technology to assist with heart surgery.

Who Needs Transesophageal Echocardiography?

Doctors may recommend transesophageal echocardiography (TEE) to help diagnose a heart or blood vessel disease or condition. TEE can be used for adults and children.

Doctors also may use TEE to guide cardiac catheterization, help prepare for surgery, or assess a patient's status during or after surgery.

Transesophageal Echocardiography as a Diagnostic Tool

TEE helps doctors detect problems with the structure and function of the heart and its blood vessels.

In general, transthoracic echo (TTE) is the first echo test used to diagnose heart and blood vessel problems. However, you might have TEE if your doctor needs more information or more detailed pictures than TTE can provide.

For TTE, the transducer (the device that sends the sound waves) is placed on the chest, outside of the body. This means the sound waves may not always have a clear path to the heart and blood vessels. For example, obesity, scarring from previous heart surgery, or certain lung problems (such as a collapsed lung) may block the sound waves.

For TEE, the transducer is at the tip of a flexible tube (probe). Your doctor will guide the probe down your throat and into your esophagus (the passage leading from your mouth to your stomach).

This approach allows your doctor to get more detailed pictures of your heart because the esophagus is directly behind the heart.

Doctors may use TEE to help diagnose:

• Coronary heart disease
• Congenital (kon-JEN-ih-tal) heart disease 
• Heart attack
• Aortic aneurysm (AN-u-rism)
• Endocarditis (EN-do-kar-DI-tis)
• Cardiomyopathy (KAR-de-o-mi-OP-ah-thee)
• Heart valve disease
• Injury to the heart or aorta (the main artery that carries oxygen-rich blood from your heart to your body)

TEE also can show blood clots that may have caused a stroke or that may affect treatment for atrial fibrillation, a type of arrhythmia.

Transesophageal Echocardiography and Cardiac Catheterization

Cardiac catheterization is a medical procedure used to diagnose and/or treat certain heart conditions. During this procedure, a long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck and threaded to your heart.

Doctors may use TEE to help guide the catheter while they're doing the procedure.

Through the catheter, doctors can do tests and treatments on your heart. For example, cardiac catheterization might be used to repair holes in the heart, heart valve disease, and abnormal heart rhythms.

Transesophageal Echocardiography and Surgery

Doctors may use TEE to prepare for a patient's surgery and identify possible risks. For example, they may use TEE to look for possible sources of blood clots in the heart or aorta. Blood clots can cause a stroke during surgery.

TEE might be used in the operating room after a patient receives medicine to make him or her sleep during the surgery. The test can show the heart's structure and function and help guide the surgery.

TEE also helps doctors assess a patient's status during surgery. For example, TEE can help check for blood flow and blood pressure problems.

At the end of surgery, TEE might be used again to check how well the surgery worked. For example, TEE can show whether heart valves are working well. TEE also can show how well the heart is pumping.

People having surgery that isn't related to the heart also may have TEE to check their heart function if they have known heart disease or a critical illness.

What To Expect Before Transesophageal Echocardiography

Transesophageal echocardiography (TEE) most often is done in a hospital. You usually will need to fast (not eat or drink) for several hours prior to the test. Your doctor will let you know exactly how long you should fast.

You should let your doctor know whether you're taking any blood-thinning medicines, have trouble swallowing, or are allergic to any medicines. If you have dentures or oral prostheses, you'll need to remove them before the test.

You may be given medicine to help you relax during TEE. If so, you'll have to arrange for a ride home after the test because the medicine can make you sleepy.

Talk with your doctor about whether you need to take any special steps before having TEE. Your doctor can tell you whether you need to change how you take your regular medicines on the day of the test or whether you need to make other changes.

What To Expect During Transesophageal Echocardiography

During transesophageal echocardiography (TEE), your doctor or your child's doctor will use a probe with a transducer at its tip. The transducer sends sound waves (ultrasound) to the heart. Probes come in many sizes; smaller probes are used for children and newborns.

The back of your mouth will be numbed with gel or spray before the probe is put down your throat. You may feel some discomfort as the probe is guided into your esophagus (the passage leading from your mouth to your stomach).

Adults having TEE may get medicine to help them relax during the test. The medicine will be injected into a vein.

Children always receive medicine to help them relax or sleep if they're having TEE. This helps them remain still so the doctor can safely insert the probe and take good pictures of the heart and blood vessels.

Your doctor will insert the probe into your mouth or nose. He or she will then gently guide it down your throat into your esophagus. Your esophagus lies directly behind your heart. During this process, your doctor will take care to protect your teeth and mouth from injury.

Transesophageal Echocardiography

Figure A shows a transesophageal echocardiography probe in the esophagus, which is located behind the heart. Sound waves from the probe create high-quality pictures of the heart. Figure B shows an echocardiogram of the heart's lower and upper chambers (ventricles and atrium, respectively).

Your blood pressure, blood oxygen level, and other vital signs will be checked during the test. You may be given oxygen through a tube in your nose.

TEE takes less than an hour. However, if you received medicine to help you relax, you might be watched for a few hours after the test for side effects from the medicine.

What To Expect After Transesophageal Echocardiography

After having transesophageal echocardiography (TEE), your or your child's blood pressure, blood oxygen level, and other vital signs will continue to be closely watched. You can likely go home a few hours after having the test.

After the TEE, you may have a sore throat for a few hours. You shouldn't eat or drink for 30–60 minutes after having TEE. Most people can return to their normal activities within about 24 hours of the test.

Talk with your doctor or your child's doctor to learn more about what to expect after having TEE.

What Does Transesophageal Echocardiography Show?

Transesophageal echocardiography (TEE) provides high-quality moving pictures of your heart and blood vessels. These pictures help doctors detect and treat heart and blood vessel diseases and conditions.

TEE creates pictures from inside the esophagus (the passage leading from the mouth to the stomach) or, sometimes, from inside the stomach. Because the esophagus lies directly behind the heart, TEE provides closeup pictures of the heart.

TEE also offers different views and may provide more detailed pictures than transthoracic echocardiography (TTE), the most common type of echo. (For TTE, the transducer is placed on the chest, outside of the body.)

Your doctor may recommend TEE if he or she needs more information than TTE can provide. TEE can help diagnose and assess heart and blood vessel diseases and conditions in adults and children. Examples of these diseases and conditions include:

• Coronary heart disease
• Congenital heart disease 
• Heart attack
• Aortic aneurysm
• Endocarditis
• Cardiomyopathy
• Heart valve disease
• Injury to the heart or aorta (the main artery that carries oxygen-rich blood from your heart to your body)

TEE also can show blood clots that may have caused a stroke or that may affect treatment for atrial fibrillation, a type of arrhythmia.

Doctors also may use TEE during cardiac catheterization. TEE can help doctors guide the catheter (thin, flexible tube) through the blood vessels. TEE also can help doctors prepare for surgery or assess a patient's status during or after surgery.

What Are the Risks of Transesophageal Echocardiography?

Transesophageal echocardiography (TEE) has a very low risk of serious complications in both adults and children. To reduce your risk, your health care team will carefully check your heart rate and other vital signs during and after the test.

Some risks are associated with the medicine that might be used to help you relax during TEE. You may have a bad reaction to the medicine, problems breathing, or nausea (feeling sick to your stomach). Usually, these problems go away without treatment.

Your throat also might be sore for a few hours after the test. Although rare, the probe used during TEE can damage the esophagus (the passage leading from your mouth to your stomach).

Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.

NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.

Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.

By taking part in a clinical trial, you may gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.

If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.

If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.

For more information about clinical trials related to transesophageal echocardiography, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:

• http://clinicalresearch.nih.gov
• www.clinicaltrials.gov
• www.nhlbi.nih.gov/studies/index.htm
• www.researchmatch.org

For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.

Links to Other Information About Transesophageal Echocardiography

NHLBI Resources

• Cardiac Catheterization (Health Topics)
• Echocardiography (Health Topics)

Non-NHLBI Resources

• Echocardiogram (MedlinePlus)

Clinical Trials

• Children and Clinical Studies
• Clinical Trials (Health Topics)
• Current Research (Clinicaltrials.gov)
• NHLBI Clinical Trials
• NIH Clinical Research Trials and You (National Institutes of Health)
• ResearchMatch (funded by the National Institutes of Health)