Transesophageal Echocardiogram (TEE): What, When, How, and Why?

by: dr. Herenda Medishita Herman Prasetya, Sp.JP, Subsp. Eko (K), FIHA

What is TEE?

A transesophageal echocardiogram (TEE) is an ultrasound examination of the heart that involves inserting a flexible probe with a transducer through the esophagus. This allows for much clearer images of the heart because it is positioned very close to the organ, without obstruction from the sternum or lung tissue—unlike a transthoracic echocardiogram (TTE), which is performed from outside the chest.

Indications and Benefits

Doctors usually recommend a TEE when more detailed cardiac imaging is needed, such as for:

• Heart valves, including detecting abnormalities or damaged prosthetic valves
• Detecting a thrombus in the left atrium or appendage
• Endocarditis, aneurysm, aortic dissection, cardiac tumor, or structural abnormality of the left atrium (ASD/PFO)
• Guidance for cardiac surgery or interventional procedures such as cardioversion or catheterization

TEE Procedure - Before, During, and After

Before Procedure:

• Fasting for approximately 6 hours (or as directed by your doctor)
• Discussion of esophageal conditions, drug allergies, or anticoagulant medications

During Procedure:

• The patient is given a mild sedative and a local anesthetic for the throat.
• A probe is inserted through the mouth into the esophagus, and images of the heart are displayed on a monitor.
• The procedure takes approximately 15–90 minutes, depending on the patient's condition.

After Procedure:

• Recovery from sedation and the effects of local anesthetics wear off.
• Your throat may feel mildly sore for a few days.

Advantages of TEE vs TTE

TEE provides sharper images of the heart and is free from physical obstructions (bones, lungs, fatty tissue), making it very useful when TTE provides less than optimal results, for example in obese or COPD patients.

Risks and Contraindications

Common risks of TEE include:

• Esophageal injury (bleeding or perforation—rare)
• Reaction to sedatives (nausea, respiratory distress)
• Arrhythmia or mild blood pressure problems
• Throat discomfort

Conclusion

TEE is an invaluable diagnostic tool in modern cardiology. By providing more detailed images of the heart, TEE helps doctors make a more accurate diagnosis and plan optimal medical interventions. Although the procedure is semi-invasive and carries some risks, the clinical benefits generally far outweigh the potential risks.
If your doctor recommends a TEE, it's important to understand the process, benefits, and risks so you can have a more informed discussion about your comfort and safety.

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