“What Happens During A Transesophageal Echocardiogram?” Asks Sophie

I just received a great, follow-up question about medical tests used to diagnose heart valve disease from Sophie.

Sophie writes, “Adam – Thanks for the recent blog about cardiac MRIs and echocardiograms. Unfortunately, my aortic regurgitation continues to become more severe. It looks like I’ll need surgery soon. To better diagnose it, I’ve been told I may need a transesophageal echocardiogram. Can you tell me what happens during a TEE? Is it painful? Thanks, Sophie”

To help Sophie better understand what happens during a transesophageal echocardiogram, I was super lucky to find an educational video that details this medical examination used to help diagnose heart valve disease.

If you have never heard the term before, a transesophageal echo uses an ultrasound transducer that is positioned on an endoscope and guided down the patient’s throat into the esophagus (the “food pipe” leading from the mouth into the stomach). The TEE test provides a close look at the heart’s valves and chambers, without interference from the ribs or lungs. TEE is often used when the results from standard echo tests are not sufficient, or when your doctor wants a closer look at your heart, according to The Cleveland Clinic.

I hope that helps Sophie (and perhaps you) learn a little more about transesophageal echocardiograms.

Keep on tickin!

Adam Pick
Written by Adam Pick

Adam Pick is a patient, author of The Patient's Guide To Heart Valve Surgery and the founder of HeartValveSurgery.com.

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  • robert witt

    I had a TEE before my aortic valve replacement and at the same time as a angiogram. The procedure was no problem and provided my cardiologist and surgeon with useful additional information.

  • lislepammysue

    Not to worry. You don’t feel a thing. You are completely out. You don’t remember a thing.

    I know the thought of something going down your throat can be very scary. BUT I repeat read the above and you will be fine. I’ve had 2 of these. The first one is the one that found my aortic stenosis—I heard the doc discussing it as I came out of my blur. The worst part of the second one is when the doc called me ‘sweetie’. I was not amused.

    Good luck. DON’T WORRY!!!!

    P. S. I really wanted to be awake for this so I could see the procedure….I am a nut.

  • Marilyn

    The TEE was the test that finally gave me a diagnosis, after a heart cath and many regular echos. It showed that I had a membrane obstructing my left ventricle outflow track. This had not shown up on any other test. I was very nervous before the test, I think fear of the unknown, but it was not bad at all. Most people fall asleep, but not me of course. The worst thing was gargleing the anesthetic and swallowing it. They said it was strawberry flavor. Ha Ha. The test is not bad at all, and very valuable.

  • George de la Flor

    I am very glad I had this test done. It makes sense and seems to give a clearer picture. I first had it done 4 years ago. At that time, the doctors were sure I should have my valve repair immediately. Regurgitation, they said, was severe. Afterward, they changed their opinions. Of course, they said surgery was in my future, but advised that perhaps I should wait a while. The while has passed and I am not gearing up for the surgery. I am insistent that they do it again because I want the surgeon to have as much information as possible, even though this time, it will not postpone the inevitable. That is so, even though I had a harder time with it than most, I think. I have a strong gag reflex and a small esophagus. You are put in a twilight sleep, so most people don’t even remember it, but you have to be conscious for it. I remember all of it, as I think it was somewhat traumatic. The tube is larger than pictured in the video and was very hard for me to get down. Though you can’t eat before hand, I nonetheless vomitted, requiring the tube to come out and them to put it back in.
    In any event, the point isn’t to intimidate. It’s all over with soon, and you are pretty much out of it during the procedure. I think I was the exception, not the rule, and even though for me it was pretty awful, I am ready, willing and able to do it again. But I don’t think you should necessarily think it is as simple as the video. It depends on your physiology. Again, I have an unusual gag reflex. I choke when I brush my teeth. And my throat and esophagus are a cause of snoring, because they are unusually small. I was also told by doctor that women have less adverse reaction. I’m not intending that to turn into a bad joke or anything. It’s just something that seems to be physiologically consistent.

  • Cheryl Irvine

    Hi Adam
    Would you please let Sophie know that a TEE isn’t painful at all. A little abdominal/chest discomfort when the doctor is working the tube that is inserted but the procedure itself is a snap. I had one a month ago and the doctor had me gargle with Novocain and then swallow the solution. Not bad tasting at all. Then he kept spraying something into the back of my throat and asking me to swallow. Once I couldn’t feel myself swallow he was ready and inserted the narrow tubing. It was down with no help from me whatsoever and I didn’t feel a thing. I laid down, the doctor completed the test and then, once I sat up, he pulled the tubing out and we were done. I didn’t feel the tubing coming out either. There was no lasting discomfort and the numbness soon was gone. Good luck Sophie.

  • Laura

    I’ve had a few TEEs. The first one was the worst, but if you know what to expect, it’s easier. They spray some stuff down your throat that’s supposedly banana scented, but it’s vile. That’s to numb your throat. As I recall, they did that two or three times, then put me out, and that was about it.
    Good luck, and this is really not anything to worry about.

  • Logan

    Funny thing, I just had one of these, yesterday in preparation for mitral valve surgery. It’s not as scary as it seems at first glance. The worst part was the stuff they spray in your throat to numb it. It tastes bad and burns a little but then the anesthetic in it kicks in and you don’t notice it anymore. For me, the probe went right down my throat and I barely felt it. They gave me some Valium and Fentanyl and told me if I was uncomfortable, I could ask for more. I didn’t need any more, but “that’s just me.” Afterward, my throat was a little sore but by evening everything felt fine. I had mine done at midday and went I got home I just took a nap. Woke up in time for dinner, took it easy for the rest of the evening and I’m back at it the following day. My throat feels fine. Of course, “your mileage may vary.” Good luck with your test.

  • Meigs Matheson

    The spray did not bother me. I remember the tube protector being put in my mouth, and beng asked to bite down on it. The next thing I remember was the nurse taking the pillows away that were supporting me on my left side. I missed the whole thing.

  • nerida

    I had one as well as an angiogram in the same day. I was awake through mine…had the banana spray and had to bite done on the tube. Just remember to breath through your nose when you feel the numbness start and breath deeply…you wont choke. It was painless and no hassle.
    good luck

  • fazilat

    hi i had tee before my aortic valve replacment same as the others who have replied. sore throat and feel a little sick afterwards also go with a empty stomach.
    good luck.

  • Linda Garbett

    I had a TEE before my mitral valve repair surgery. I was a bit nervouse before it but it was really quite easy.
    All the best

  • Melinda

    I’ve had two TEEs. I was nervous going into the first one because I didn’t know what to expect. It turned out to be a breeze compared to what I thought it would be like. To me, the worst part was getting the IV. You’ll be asked to swallow spray. Simulataneously, they started me on the sedative through the IV. I was “knocked out” for just long enough for the procedure. I wasn’t afraid at all to get the second TEE. I hope this helps you. Good Luck!

  • Don

    I’ve had two TEE’s in the last year, prior to my mitral valve replacement surgery. In my experience, they are nothing to dread. An IV is inserted in your arm, some local anesthetic is usually sprayed in your throat, you’re told to bite gently on the mouthpiece, and then about ten minutes later, you wake up. It’s really a fairly straightforward procedure from what I experienced.

  • Mary Ferraro

    Not to worry. I had 2 done before my valve repair last year. You lay down. You get an IV. You go to sleep. The next thing you know, the 2 nurses are standing there with the classic quote, “Oh, look. This ones waking up.” Really all very easy and nothing to be afraid of.

  • Audrey schmida

    I had my TEE July 12, 2011 and the anticipation is worse than procedure. I had my test performed at new Ahuja Medical Center in Cleveland and the doctor and nurses put me at ease before procedure. I woke up during the test but once the nurse realized I was awake they put me out again. If you start with positive
    attitude it is a breeze. Glad I had it done as it gave the cardiologist clear view of mitral valves.

  • Tom Mullin

    I just had a TEE last Friday. Based on my experience, there is nothing to be concerned about. My main worry was swallowing the tube. The memory of everything after the throat numbing is a little hazy because of the sedative, but you are not allowed to be totally unconscious in order to swallow when instructed. That isn’t a problem, if you remain relaxed.

  • crystal m

    Thank you for reporting your expirences.. Makes me feel a little better about my up coming procedure.

  • Linda

    Hello, I have a TEE scheduled for Monday. I am deathly afraid of being put out and want to be awake for this. However I am still freaking out over the idea of the numb throat. Basically everything about this. I was told I can be awake that it would be uncomfortable I am hoping this is true. I am totally freaking out!

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