A transesophageal echocardiogram (TEE) is a specialized type of echocardiogram (heart ultrasound) that captures images from inside your body. During a standard echocardiogram, the probe is placed on your chest wall. However, fat, ribs, and lung tissue can block the sound waves.
By passing a thin, flexible tube (endoscope) with an ultrasound probe down your esophagus (food pipe), the probe sits directly behind your heart. This provides highly detailed, clear images of the heart's valves and chambers without any structures blocking the view.
Common Indications for a Transesophageal Echocardiogram (TEE)
- Investigating heart valve infections (infective endocarditis).
- Checking for blood clots in the heart chambers before treating abnormal heart rhythms (like atrial fibrillation).
- Evaluating artificial heart valves for leakage or damage.
- Assessing congenital heart defects or tears in the main artery (aortic dissection).
- Providing real-time imaging guidance during heart surgeries.
What exactly does a transesophageal echocardiogram (TEE) show?
The scan shows the movement of your heart chambers, the structure and function of your heart valves, and the flow of blood through the heart. It is exceptionally good at showing tiny blood clots, infections on the valves, or small holes in the heart walls.
How should I prepare for a transesophageal echocardiogram (TEE)?
Follow the centre's written fasting instructions. Solid-food and clear-liquid cut-offs may differ according to sedation policy, urgency, and medical conditions, so do not assume “nothing including water for six hours” applies to everyone. Arrange an escort and transport if sedation is planned, and disclose swallowing problems, oesophageal disease, dentures, allergies, sleep apnoea, and previous sedation problems.
Do I need to stop taking medication?
Take your essential medications at your normal time with a very small sip of water, unless instructed otherwise by your cardiologist. If you take diabetes medications or blood thinners, discuss specific instructions with your doctor.
What happens when I arrive for my scan?
You will lie down on a bed. An intravenous (IV) line will be inserted into your arm to give you sedative medications. Your throat will be sprayed with a local anesthetic to numb it. Sticky patches (ECG electrodes) will be placed on your chest to monitor your heart rate.
How is the procedure performed?
You will lie on your left side. You will be given a plastic mouthguard to protect your teeth. The cardiologist will inject sedatives through your IV to help you relax. They will then gently guide the thin, lubricated tube down your throat into your esophagus. You will be asked to swallow to help the tube pass. Once in position, the cardiologist will take ultrasound images. The tube does not interfere with your breathing.
How long does a transesophageal echocardiogram (TEE) take?
The actual scanning time is about 10 to 20 minutes. Including preparation, sedation, and recovery time, you will spend about 2 hours at the clinic.
Is there any discomfort?
Yes. You will feel a gagging sensation as the tube is first passed down your throat, but the numbing spray and sedatives will help control this. You will not feel the tube once it is in place. You may have a mild sore throat for a day or two after the procedure.
Are there risks?
Yes, but they are rare. The main risk is a sore throat or minor bleeding in the throat. There is a very rare risk of a tear in the esophagus (less than 1 in 10,000 cases) or reaction to the sedative medications.
Can children have this scan?
Yes. Pediatric TEE is performed under general anesthesia to ensure the child's safety and comfort.
Can I have this scan if I am pregnant?
Yes, TEE uses sound waves and has no radiation. However, because it involves sedation, TEE is only performed during pregnancy when absolutely necessary for maternal health.
When will I get my results?
The cardiologist will review the images in real-time. A preliminary result is often discussed before you leave, and a final report is sent to your referring doctor within 24 hours.
What if the scan finds something?
If the scan detects a clot, infection, or valve leakage, your cardiologist will discuss treatment plans, which could include starting blood thinners, prescribing intravenous antibiotics, or scheduling surgery.
When should I seek urgent help after TEE?
Seek urgent care for severe chest or neck pain, difficulty breathing, vomiting blood, black stool, fever, or inability to swallow after the procedure. Follow the sedation instructions, do not drive or make important decisions for the stated period, and do not eat or drink until throat sensation and swallowing have safely returned.
What are the important limitations?
Ultrasound does not use ionising radiation, but a useful result still depends on the clinical question, the operator, the equipment, patient anatomy, and whether the target can be reached by sound waves. Gas, bone, body habitus, pain, movement, and a limited acoustic window can hide disease. A normal scan does not automatically exclude the suspected condition; persistent or worsening symptoms need clinical reassessment and sometimes repeat ultrasound, CT, MRI, laboratory tests, or another specialist test.
Ultrasound should be used for a medical purpose, with output and examination time kept as low as reasonably achievable—especially in pregnancy and with Doppler. Internal scans and procedures require explanation, consent, privacy, and a chaperone according to patient preference and local policy.
Questions to ask your care team
- What exact question should this ultrasound answer, and could anything important remain unseen?
- Is this a screening, diagnostic, surveillance, or procedure-guidance examination, and will the result change care?
- What preparation is required, and should I continue all medicines unless my own clinician gives different instructions?
- When will I receive the signed report, who will explain it, and what symptoms should prompt urgent assessment rather than waiting?
Sources and further reading
Conclusion
TEE provides close views of selected heart structures but is semi-invasive and may require sedation. Follow the centre's individual fasting, medication, escort, and post-sedation instructions, and seek urgent help for severe pain, bleeding, breathing difficulty, or inability to swallow afterward.