Transoesophageal Echocardiogram

What is a trans oesophageal echocardiogram (TOE)?

TOE is a specialised type of heart study where ultrasound images of the heart are taken from a transducer positioned in the oesophagus behind the heart. This gives a more detailed picture and information than the traditional (transthoracic) echocardiogram, which is performed by moving a probe on the chest wall.

The TOE probe is guided down your throat and into the oesophagus; there it sends and receives sound waves reflected back from the heart. These reflected Sound waves are processed by a special computer that converts the echoes into a moving image of the heart displayed on a video screen. The procedure is performed by a Cardiologist or an anaesthetist.

A short acting anaesthetic will be administered to you by an anaesthetist so that you will be sedated when the actual procedure takes place.

Why you might require a TOE?

Your doctor may want you to undergo a TOE for a variety of reasons, including patients who:

• Are difficult to image with a standard echocardiogram
• Have congenital heart disease
• Have undergone heart valve replacement surgery
• Are suspected of having heart valve infections (endocarditis)
• May have a blood clot, tumour or mass inside the heart
• Are candidates for repair or replacement of the valves
• May have a tear (dissection) of the aorta (main artery of the body)
• Prior to having a cardioversion or ablation procedure

What are the risks?

TOE is a relatively common procedure but does require sedation and probe placed into your mouth, oesophagus and stomach. Risks are uncommon (<2-3%) but does include damage to your teeth, aspiration, laceration to your mouth and back of throat, bleeding, haematoma, damage to your oesophagus requiring surgery.

What is involved in having a TOE?

Your admission:

On admission, usually to DOSA (Day of Surgery Admission) you will be greeted by members of the healthcare team who will be caring for you before, during and after your procedure.

It is important that you bring in your medications in their original packets with you and inform your doctor or nurse of any medication you have been taking at home.

Your preparation:

• No food or fluids to be taken for a minimum of 6 hours prior to the procedure.
• Follow your doctor’s advice regarding stopping or continuation of medications. Diabetic patients should NOT take their morning insulin/diabetic medications, but should bring them along with you
• You won’t be able to drive afterwards because of the sedative used during the procedure. Be sure to make arrangements to get home before you have your procedure
• The nurse or anaesthetist will put a small needle into your arm or hand in order to administer the sedation
• A brief medical history will be taken by the nurse and you will be given a consent form to sign with your nurse or doctor prior to the procedure

During the procedure:

The procedure lasts less than one hour. During this time your heart rate, blood

pressure and oxygen levels are closely monitored. The anaesthetist may spray a liquid local anaesthetic to the back of your throat which may taste a little bitter. You may also be asked to gargle and swallow a liquid anaesthetic. A sedative will then be given into your arm to help you relax. Before you sleep, a mouth guard will be put in place and the doctor may ask you to swallow as the probe is passed. Once you are adequately comfortable, the probe will be passed down your gullet / oesophagus until it is positioned behind the heart. From this position, the probe is able to perform detailed analysis of your heart structure and function. Images will be stored for review as needed. Procedure usually lasts about 30mins to 1 hour.

After the procedure:

After the test, the probe and electrodes are removed. You will wake quickly after the procedure, but it is common to remain drowsy up to two hours. You will be observed in the hospital for two hours after the test until you have recovered from the anaesthetic and your condition is stable. You may feel slightly numb at the back of the throat – this will subside as the local anaesthetic wears off. You will be allowed to eat and drink approximately one to two hours after the anaesthetic when you are fully awake. After this time the intravenous drip will be removed from your arm. Remember, you will NOT be allowed to drive home yourself.