Transesophageal echocardiography (TEE)

A transesophageal echocardiogram, or TEE, is a procedure in which the ultrasound probe is inserted into the esophagus and ultrasonographic images are obtained of the heart using 2D echocardiography and color Doppler images. This requires conscious sedation.

According to the appropriateness criteria from the American Society of Echocardiography, the indications for TEE are:

  • when visualization of cardiac structures in not adequate with transthoracic echocardiography;
  • to evaluate valvular structure and function in preparation for an intervention (surgery);
  • to diagnose infective endocarditis when there is a moderate or high pre-test probability;
  • to evaluate patients with atrial fibrillation or atrial flutter to facilitate clinical decision making in regard to anticoagulation, cardioversion or ablation;
  • evaluation of acute aortic pathology (such as ascending aortic dissection);
  • evaluation of cardiovascular source of embolus (frequently causing an embolic stroke) with no identifiable non-cardiac source;
  • re-evaluation of a prior TEE finding (ie, resolution of a thrombus or endocarditis); and
  • guidance during percutaneous non-coronary interventions (ie, atrial septal defect closure).

While TEE images are frequently higher resolution than transthoracic echocardiographic images, the views available during TEE are limited. Transthoracic echocardiography is superior in wall motion analysis. Also, the continuous wave Doppler angle is ideal with transthoracic echocardiography to determine the right ventricular systolic pressure (RVSP) and to measure the pressure gradient across the aortic valve in the setting of aortic stenosis. These can be difficult with TEE and are frequently underestimated.

Complications of TEE are rare and include those associated with conscious sedation, esophageal rupture (requires emergent surgical repair) and bleeding.