What to expect before, during and after a transoesophageal echocardiogram

A transoesophageal echocardiogram is an advanced diagnostic procedure that produces detailed images of the heart and its structures. This article explores why a transoesophageal echocardiogram is performed, how the procedure is conducted, and what to expect afterwards, including the results.

Why might I need a transoesophageal echocardiogram?

A transoesophageal echocardiogram is performed when your cardiologist needs to obtain detailed, clear images of the heart and its surrounding structures, particularly when other imaging methods might not be sufficient.

The procedure can help diagnose a range of heart conditions, including:

• Heart valve disorders, such as regurgitation (leakage) and stenosis (narrowing).
• Endocarditis, caused by bacterial or fungal infections.
• Blood clots that may be present in the heart.
• Congenital heart defects.
• Aortic disease, such as dissection (tears) or aneurysms (bulging).

How should I prepare for a transoesophageal echocardiogram?

You will need to fast (no eating or drinking) for at least 6 hours before the procedure. This is important as the stomach must be empty to reduce the risk of aspiration (inhaling food or liquids into the lungs) during the test.

If you take medications, you will also need to inform your cardiologist beforehand. In many cases, your cardiologist will adjust your medication schedule or temporarily pause certain medications, especially blood thinners, a few days prior to the test.

Additionally, you will need to inform your cardiologist if you have a history of oesophageal problems or swallowing difficulties, allergies to anaesthesia or medications, or any existing heart conditions, as these might affect the procedure.

How is a transoesophageal echocardiogram performed?

You will be given a sedative to help you relax, and a local anaesthetic will be sprayed into your throat to numb the area and reduce discomfort during the procedure.

Once sedated, your cardiologist will gently insert a flexible probe (with an ultrasound transducer at its tip) through your mouth and into the oesophagus. The probe will then be positioned behind the heart, allowing your cardiologist to capture images without interference from the ribs or lungs.

Your cardiologist will move the probe slightly to get various angles and views of the heart. The sound waves from the probe will bounce off the heart structures, creating real-time images that will be displayed on a monitor for analysis. The images will help assess heart function, blood flow, and structural problems.

In some cases, your cardiologist will ask you to change positions slightly or hold your breath for better images.

The procedure typically lasts between 30 to 60 minutes. It’s typically not painful, but you may experience some discomfort from the throat numbing and the presence of the probe. The sedation provided before the test will ensure you are relaxed and at ease throughout the process, and any discomfort will usually pass quickly.

What post-procedure care do I need to follow after a transoesophageal echocardiogram?

After the procedure, you will be monitored for a short period until the sedatives wear off. Most people are able to go home the same day, but you will need someone to drive you, as the sedatives will affect your ability to operate a vehicle safely.

A mild sore throat is a common side effect due to the insertion of the probe, but this usually resolves within 24-48 hours. Over-the-counter pain relievers like paracetamol can help reduce any discomfort.

Lastly, you will need to wait for the numbness in your throat to wear off before eating or drinking after the procedure. This typically takes around 1-2 hours - you shouldn’t swallow anything before this time to prevent choking.

When will I get the results after a transoesophageal echocardiogram?

The results of a transoesophageal echocardiogram are usually available within a few hours after the procedure. In some cases, your cardiologist will be able to discuss preliminary findings with you immediately, but generally a detailed report will be provided within 1-2 days after a thorough analysis.

Once the results are available, your cardiologist will contact you to schedule a follow-up appointment to discuss the findings and the next steps in your treatment. If urgent issues are detected, your cardiologist will reach out sooner.