Transcription
Hey, I'm Dr. Chris Kelly, and in this video, I'll be explaining everything you need to know about a transesophageal echocardiogram, also known as a TEE. In case your doctor has ordered this test, so you know what to expect on the day of your exam.
So, a TEE is just an ultrasound of the heart. But unlike a regular echocardiogram, which is taken by placing a probe on the skin of your chest and getting pictures from the outside in, this is taken by placing an ultrasound probe into your mouth and down into the esophagus, which is the tube between your mouth and stomach, and taking ultrasound pictures of the heart from the inside out. And that may sound crazy, but it provides a much more detailed view of heart valves and other structures that we don't see quite as well with a regular ultrasound. And that's really helpful for assessing a leaky valve, for example, or if we're planning a possible intervention on a valve, or if we're looking for a blood clot inside the heart, or trying to measure how enlarged the aorta is, which is the main artery coming out of the heart, or whether there's even a tear in the wall of the aorta. All those things are much easier to assess with a transesophageal echocardiogram rather than a regular transthoracic echocardiogram.
It's typically performed either at a doctor's office or, more commonly, in a hospital. It's generally considered very safe, and we'll go over some of the risks a little bit later. And the whole procedure itself takes about 30 to 45 minutes in most cases. However, that doesn't account for the time spent getting checked in, getting into the bed, and, you know, interviewed by the nurses, and then recovering afterwards from the sedation. So, you should plan to be at the procedure for probably a total of two to three hours.
Preparation is pretty straightforward. All you have to do is not eat or drink anything other than little sips of water for your medicines on the morning of your test. And unless your doctor tells you otherwise, you can take all your usual medications. You should plan to get a ride home from your test because you'll receive sedation, and you might be a little woozy afterwards, and you don't want to get behind the wheel in that kind of condition.
The test starts by placing what are called telemetry leads on the chest. Basically, these white stickers are placed onto the chest and connected to wires that go back to the ultrasound machine. This allows us to take pictures synched up with the electrical signal coming from your heart. A very, very small number of people with sensitive skin might have a little bit of reaction to this, but from 99% of people, it's no big deal. Guys, if you have a super hairy chest, we may have to shave little areas in order to get these to actually stick.
After those are on, the first step is going to be to numb the back of your throat. Since we're placing something into your throat, we want to make sure there's no sensation there. And I should mention also, if you have any loose teeth, dentures, or anything else in your mouth that could come out during the procedure, it's going to have to come out now, too. The nurses will prepare this lidocaine solution. Lidocaine is a numbing medicine, and you're going to gargle it in the back for about 30 seconds to a minute and then swallow it. Warning: it tastes terrible. Everyone hates it. I'm really sorry. This is often the worst part of the procedure, but it's really important to do a good job gargling this stuff because it'll numb up the back of your throat really effectively and make the rest of the procedure much more tolerable. After this is done, we may spray some additional lidocaine or similar medicine in the back there just to make sure everything's totally numb.
Next step is to roll you onto your side and give you some medicine to help you start to fall asleep. And as you're falling asleep and kind of drifting off into lala land like this guy, we're actually going to place what's called a bite block in your mouth. So, this is like a little thing that goes between your teeth and keeps your mouth open and your teeth apart. So, your teeth are kind of around here, and your lips are around this thing, too. And that's so that when you're sleeping, you won't bite down on the ultrasound probe or do anything that could interfere with the test. So, you may dream that you're like a hockey goalie or something because this will be in your mouth while you're having the procedure.
And then we insert the ultrasound probe into your mouth. It looks something like this. It's pretty long. It's probably about the size of the length of your forearm, or rather, your entire arm. But you're going to be asleep for most of this. When the ultrasound probe is first inserted, you might wake up a little bit. You might feel a little pressure or heaviness in the back of your throat. Try to just swallow, and that'll help it go down much easier. Most people, if they're awake when this is first inserted, fall asleep shortly after it makes it down, and then they're asleep for the rest of the test. We'll then manipulate the probe inside the body to take pictures.
And just to give you an example of how great the pictures can be, you know, this is what a regular ultrasound looks like, as we mentioned in a different video, and it's showing the heart. But this is the kind of detail we can see on a transesophageal echocardiogram. It's much crisper, and we can create these 3D pictures, which are really remarkable and allow us to assess the valve in a lot more detail. So, we'll spend about 20 to 30 minutes taking pictures. In a more complicated case, maybe more like 30 to 45. Then we take the ultrasound probe out. Then you're done. At that point, we roll you back onto your back, take the mouthpiece out, and allow you to recover.
As I mentioned earlier, it's a very safe procedure. It's very, very uncommon to see any kind of complications. This is about a one in 2,500 to one in 5,000 chance of a serious complication happening. The serious complications we worry about the most are just mechanical interactions between the ultrasound probe and the throat. So, a tooth could become dislodged, or actual damage to the esophagus could occur because of the ultrasound probe. If you have a history of problems with the esophagus, tightened areas of the esophagus, or surgeries on the esophagus, we won't even do the procedure. But even people with a healthy esophagus can every now and then run into problems. But thankfully, it's very rare, and we do this procedure very carefully, so the risks are minimal.
So, I wish you well with your procedure. I hope it all goes smoothly for you, and I hope this video helped you understand what it's all about. Thanks so much.