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Transoesophageal echocardiogram

Published by Bupa's health information team, June 2008.

This factsheet is for people who are planning to have a transoesophageal echocardiogram (TOE), or who would like information about it.

An echocardiogram uses ultrasound to produce moving 'real time' images of the inside of your heart. In a TOE, the ultrasound probe is placed in your oesophagus (the pipe that goes from your mouth to your stomach), to take the images of your heart.

About transoesophageal echocardiograms
What are the alternatives?
Preparing for your procedure
About the procedure
Getting your results
What are the risks?
Further information
Questions and answers
Related topics
Sources

About transoesophageal echocardiograms

An echocardiogram works by bouncing sound waves off the various structures in your heart - such as the walls of the heart and the heart valves.

Transoesophageal means that the images are taken from inside your oesophagus, which lies just behind your heart. This allows your doctor to get a clearer view of your heart than with a standard echocardiogram, which takes the images through your chest, as there is no interference from your ribcage and lungs. The test is particularly useful when doctors need to get a good view of your heart valves. A TOE may be carried out to check for:

problems with your heart valves
infection of the heart tissue
tears in the aorta (the largest artery in the body)
damage to the heart muscle
a blood clot in your heart

What are the alternatives?

Alternative procedures for getting images of your heart include:

a standard echocardiogram - in this type of echocardiogram, the ultrasound probe is run over your chest
a stress echocardiogram - similar to a standard echocardiogram, but this is carried out when your heart is under stress (either after exercise or after being given a medicine)
a radionuclide test - in this test, you are injected with a harmless, radioactive substance, which is picked up on a special camera as it travels through your heart
cardiac MRI (magnetic resonance imaging test) - this uses magnets and radiowaves to produce images of the inside of your heart

Preparing for your procedure

A TOE is carried out in hospital by a cardiologist (a doctor specialising in conditions affecting the heart) or a technician trained in the procedure (a sonographer). You will be asked to attend the hospital as an out-patient and should follow any instructions given to you in your appointment letter.

You will be asked not to eat or drink anything before the procedure - this may be for up to six hours beforehand. You will also need to arrange for someone to take you home.

At the hospital, your cardiologist will discuss the test with you and ask you to sign a consent form. This confirms you have given your permission for the scan to go ahead.

About the procedure

You may have to stay in hospital for a few hours for a TOE. The procedure takes place in a private room, and you may be asked to change into a hospital gown before it begins. You will have a local anaesthetic sprayed on the back of your throat. This will numb your throat. You may also have an injection of a sedative, which will help you to relax and relieve any anxiety. You will be given a plastic mouth guard to protect your teeth.

You will be asked to lie on your side and to swallow a small probe, which is mounted on the end of a flexible tube. When the probe is turned on, it will give out ultrasound waves, which bounce off the various structures in your heart and are detected by the echocardiogram machine. You won't be able to feel the ultrasound waves. The images of your heart that are produced by the echocardiogram machine will be displayed on a screen.

The procedure itself usually takes 15 to 20 minutes. You will normally be given some time to rest after it has finished.

If you have had a sedative, you may need to stay in the hospital for a couple of hours. Sedation temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours if you had a sedative.

You will also usually be told not to eat or drink anything for two hours after a TOE, until the local anaesthetic has worn off.

Illustration showing the ultrasound probe which is passed through the oesophagus to view the heart
The ultrasound probe is passed through the oesophagus to view the heart

Getting your results

The results of your echocardiogram may be discussed with you immediately after the examination. Alternatively, your results may be sent to the doctor who requested you have the test (eg, your GP), who will discuss them with you at your next appointment.

What are the risks?

TOEs are commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

Side-effects are the unwanted but mostly mild and temporary effects of a procedure. There may be some side-effects with a TOE. For example, the back of your throat may feel sore and swallowing may be uncomfortable after a TOE. This should wear off very quickly.

Complications

This is when problems occur during or after a procedure. Most people are not affected. There is a small possibility that you may get small injuries to your mouth or oesophagus during the test. These should also settle very quickly, and do not normally need any treatment. Other complications are very rare.

The exact risks are specific to you and differ for every person. Ask your cardiologist to explain how these risks apply to you.

Further information

British Cardiac Patients Association
01223 846845
www.bcpa.co.uk
British Heart Foundation
08450 70 80 70
www.bhf.org.uk