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At the heart of general practice since 1960

Cardiac tests - transoesophageal echocardiography

Cardiologists Dr Clive Handler and Dr Gerry Coghlan continue their series on tests commonly used in primary care

Cardiologists Dr Clive Handler and Dr Gerry Coghlan continue their series on tests commonly used in primary care

Transoesophageal echocardiography is complementary to the ‘traditional' transthoracic echocardiography. It is performed on outpatients in cardiac units, and often in very ill patients and produces clearer images of the heart than transthoracic echocardiography because the probe is closer to the heart.

The test

Patients should fast for at least four hours before the test, and must sign a consent form. Some patients are unable to swallow the probe and find the procedure unpleasant, but with satisfactory preparation, explanation, sedation and pharyngeal anaesthesia, most patients tolerate the procedure well.

The test is contraindicated in patients with dysphagia, oesophageal problems, respiratory disease or severe coagulopathy, and in those who are unable to co-operate.

The patient's ECG, oxygen saturation and blood pressure are monitored during the procedure, as probe passage down the oesophagus may cause hypertension.

The test takes around 30 minutes and complications are rare, occurring in 0.3% of patients. They include oesophageal perforation, arrhythmia, heart failure and laryngeal spasm.

Mortality is reported to be one in 10,000, but the risk is mainly in very ill patients.

Indications

Inadequate transthoracic echocardiography

• airways disease

• obesity

• breast implants

Atrial thrombus/myxoma

• before cardioversion

• radio-frequency ablation

• closure of atrial septal defect

Prosthetic heart valve

• function

• thrombus

• vegetations

Aortic disease

• suspected dissection

Endocarditis on a native or prosthetic valve

• vegetations

• abscess

Congenital heart disease

• cardiac anatomy

Atrial septum

• patent foramen

• septal defect

Unexplained stroke in young people

• intracardiac thrombus/myxoma

• patent foramen

• atrial septal defect

• aortic/mitral vegetations

Value and limitations

This procedure provides very clear anatomical information about the cardiac structures, but involves oesophageal intubation, which carries a small risk of complications. It permits echocardiographic investigation in patients who are anaesthetised and unconscious in the intensive care unit, and in those with chest wall problems or dressings that prevent adequate transthoracic study.


Dr Clive Handler is consultant in pulmonary hypertension at the Royal Free Hospital, London

Dr Gerry Coghlan is consultant cardiologist at the National Pulmonary Hypertension Unit, Royal Free Hospital, London

This article is based on a chapter in Management of Cardiac Problems in

Primary Care by Dr Clive Handler and Dr Gerry Coghlan, published by Radcliffe, which is offering a 20% discount on this book to Pulse readers (usual price £29.95+p&p, offer price £23.96+p&p). To claim, order via www.radcliffe-oxford.com or by telephone on 01235 528820. Please quote discount code ‘Pulse'. Offer expires 31 May 2009

Patient information

Patient information

• Transoesophageal echocardiography is a newer test in which the probe is passed into your stomach – it sounds difficult, but it is quite straightforward.
• The probe and cable are the width of a pen. The doctor will spray the back of your throat with local anaesthetic and you will be asked to swallow the probe, which should pass easily.
• The pictures obtained with transoesophageal echocardiography are clearer than those obtained with conventional [transthoracic] echocardiography.
This is because the probe is closer to the heart, and the pictures of the heart are not obscured by the overlying lung.

Transoesophageal echocardiography Transoesophageal echocardiography

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