​Children's Heart Center

Transesophageal Echocardiogram

Transesophageal echocardiography is often referred to as TEE, or endoscopic cardiac ultrasound. TEE uses a small endoscopic-like cardiac ultrasound probe guided into the esophagus to closely evaluate the heart and blood vessels within the chest.

Transesophageal echocardiography is often used to:

  • Evaluate the internal heart structures and path of blood flow in congenital heart defects
  • Evaluate the effects of surgical intervention to the heart or repair of congenital heart defects during heart surgery
  • Evaluate pulmonary disease when transthoracic echocardiography is unable to provide adequate imaging due to lung tissue density or interference
  • Better visualize and evaluate conditions of the heart, such as mitral valve disease, blood clots or masses inside the heart
  • Evaluate discrete dissection (tear) of the lining of the aorta
  • Better visualize and evaluate implanted prosthetic heart valves

Performing Transesophageal Echocardiography

  • TEE is considered a minimally invasive endoscopic-type procedure and is typically performed in a specially equipped procedure or surgical suite.
  • Transesophageal echocardiography is performed by a specially trained pediatric cardiologist and a registered pediatric echocardiographer to closely evaluate the heart and blood vessels within the chest.
  • TEE is only performed when the patient is sedated or asleep under general anesthesia Sedation or general anesthesia services are provided by pediatric anesthesiologist and nurses with advanced training.
  • TEE uses a specialized cardiac ultrasound probe with a transducer on the end that is guided through the throat and into the esophagus to a location that is aligned in close proximity to the heart.
  • The TEE transducer works the same as the one used in transthoracic echocardiography (TTE). A transducer sends out ultrasonic sound waves at a frequency too high to be heard.
  • When the transducer is positioned within the esophagus at certain locations and angles, the ultrasonic sound waves moves through the esophagus and other internal tissue to the heart tissue, where the waves “echo” off of the heart structures.
  • The transducer picks up the reflected waves and sends them to a computer. The computer interprets the echoes into an image of the heart walls and valves.
  • The advantage is that this method of acquiring cardiac ultrasound data can often provide a much clearer image because the sound waves do not have to pass through skin, muscle or bone tissue.
  • As with TTE, TEE can utilize one or more of four special types of echocardiography:
    • M-mode echocardiography – This is the simplest type of echocardiography, and it produces an image that is similar to a tracing rather than an actual picture of heart structures. M-mode echo is useful for measuring heart structures, such as the heart’s pumping chambers, the size of the heart itself and the thickness of the heart walls.
    • Doppler echocardiography – This technique is used to measure and assess the flow of blood through the heart’s chambers and valves. The amount of blood pumped out with each beat is an indication of the heart’s functioning. Also, Doppler can detect abnormal blood flow within the heart, which can indicate such problems as an opening between chambers of the heart, a problem with one or more of the heart’s four valves or a problem with the heart’s walls.
    • Color Doppler – This technique is an enhanced form of Doppler echocardiography. With color Doppler, different colors are used to designate the direction of blood flow. This simplifies the interpretation of the Doppler technique.
    • 2-D (2-dimensional) echocardiography – This technique is used to “see” the actual structures and motion of the heart structures. A 2-D echo view appears cone-shaped on the monitor, and the real-time motion of the heart’s structures can be observed. This enables the physician to see the various heart structures at work and evaluate them.

Use of Sedation and Anesthesia for TEE

Unlike transthoracic echocardiography, TEE is considered a minimally invasive endoscopic type procedure. To perform the procedure safely and effectively, it is necessary that patients be sedated or be placed asleep with general anesthesia. This requires the expertise of doctors and nurses with advanced training in pediatric anesthesiology and sedation.

Sedation or anesthesia medications are administered intravenously. If required, a special tube is also placed to maintain the patient’s breathing during the procedure. One of our board-certified pediatric anesthesiologists will perform and continuously monitor the sedation or anesthesia. When the procedure is completed, the breathing tube will be removed and the child will recover in a special-care area.

With sedation or anesthesia, the patient may feel groggy, tired or sleepy for a period of several hours after the exam. However, these effects will usually disappear within a day or so.