Transesophageal Echocardiogram

What is it?

The transesophageal echocardiogram (EcoTE) is an echocardiographic examination in which ultrasounds are produced by a probe placed in the esophagus, in order to obtain a better visualization of certain structures of the heart. EcoTE is performed in cases where the transthoracic echocardiogram (EcoTT) is not sufficient to solve a specific diagnostic question. EcoTE enables visualization of a different exploration point of the heart, using an echocardiographic probe that visualizes the cardiac structures posteriorly through the esophagus (i.e. the stretch of the digestive system that connects the mouth with the stomach passing behind the heart, in close contact with the heart atria). For the patient, the discomfort of performing an echocardiogram transesophageally is equivalent to performing a common gastroscopy.

When is this exam indicated?

In some situations, it may happen that the transthoracic echocardiogram (EcoTT) is not sufficient to solve a diagnostic problem. This can happen due to the presence of a poor quality transthoracic acoustic window (for example in the presence of large muscle masses or in case of lung disease (emphysema), or in the presence of artificial metal structures (for example mechanical valve prostheses) that create reverberations and image artifacts.

In other cases, EcoTE may be necessary for having high definition images, for observing even very small formations (for example a thrombus at the level of the atria), or for accurately assessing the extent of a valve disease (for example a severe mitral valve insufficiency). EcoTE is often recommended before performing Electrical Cardioversion, to exclude the presence of thrombi at the level of the atria.

How is it performed?

After reading and signing the Informed Consent, the patient is invited to take off his glasses and remove any dental prostheses, is connected to the electrocardiographic monitoring, and venous access is obtained (to administer any drugs in case of need).

The patient is placed on his left side with his torso and neck slightly flexed (as if looking at his legs). The doctor, after inserting a mouthpiece between the teeth so as not to damage the probe, will help the patient in the unpleasant but not dangerous task of swallowing the probe.

Typically, mild local anesthesia of the mouth and back of the mouth (pharynx) is performed with lidocaine spray (a local anesthetic). The throat, due to the action of the local anesthetic, can be slightly irritated, so it is not recommended to drink or eat for 2-3 hours after the examination. The overall duration of the procedure is approximately 10-15 minutes.

The examination is annoying but, if the patient manages to collaborate (breathing slowly and trying to relax the muscles of the neck and shoulders) and to remain calm, the discomfort is significantly reduced. The most difficult moment is that of the introduction of the probe: at that moment, coughs, belching, and vomiting can occur. It is important to know that the tube does not interfere with normal breathing, which occurs naturally through the nose and trachea.

During the examination, the ECG tracing, blood pressure, and oxygen saturation is continuously monitored as needed. In case of patient intolerance and inability to adapt to the probe, the examination is immediately interrupted.

At the end of the exam, in particular if it was necessary to administer a sedative, it is advisable to wait at least 30 minutes before leaving the hospital and avoid driving immediately after the exam.

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It can be quite uncomfortable and your throat may hurt for a few hours after the exam. Driving for the next 24 hours is not allowed due to the sedation used, which can cause drowsiness. Also, there is a possibility that the probe may damage the throat and esophagus (a very rare complication).  Contraindications to the execution of transesophageal echocardiogram with a full doppler are esophageal diseases and especially esophageal varices, usually secondary to major liver diseases such as cirrhosis or cancer cirrhosis and portal hypertension (of the portal vein).

The patient is however required to inform the doctor of the presence of any: serious infections, drug allergies, glaucoma, lung disease, previous surgery in the gastrointestinal tract, liver disease, difficulties with swallowing.

The complications of EcoTE, as mentioned, are very rare. However, the following symptoms should be reported to the Cardiologist, in the rare case that they arise after the examination:

  • Unusual pain or tough swallowing
  • Abdominal or chest pain
  • Vomiting of coffee or blood color.

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