Transesophageal Echocardiogram (TEE): Purpose, Procedure, Risks, Results

When your cardiologist says, “We need a closer look at your heart,” they’re not talking about writing you a love poem.
Sometimes, a regular echocardiogram (the one done over your chest) doesn’t show enough detail. That’s when a
transesophageal echocardiogram (TEE) steps in for its close-up, sending a tiny ultrasound camera down your esophagus to get high-definition images of your heart.

TEE sounds a bit intimidating at first there’s a tube, sedation, and a lot of medical equipment but it’s a
commonly used, low-risk test that helps doctors find serious problems like blood clots, valve disease, and infections
before they cause major trouble. Major heart centers and organizations such as Cleveland Clinic, Mayo Clinic,
Johns Hopkins, and the American Heart Association all describe TEE as a powerful diagnostic tool that’s especially useful
when a standard echocardiogram can’t tell the whole story.

Let’s break down, in plain English, why a TEE is done, what actually happens during the procedure,
what risks you should know about, and how to understand the results with a little reassurance and
a dash of humor along the way.

What Is a Transesophageal Echocardiogram (TEE)?

A transesophageal echocardiogram is a type of heart ultrasound that takes pictures from inside your body.
Instead of placing the ultrasound probe on your chest like in a standard transthoracic echocardiogram (TTE), your provider
guides a thin, flexible tube with a small ultrasound transducer at the tip down your throat and into your esophagus.
Because the esophagus runs right behind the heart, this “backstage pass” gives clearer, more detailed images of structures
that can be hard to see from the outside, especially the left atrium, heart valves, and upper part of the aorta.

The test uses high-frequency sound waves (not radiation) to create moving pictures of your beating heart.
The transducer sends out sound waves, which bounce off your heart structures. A computer turns those echoes into images
that your cardiologist can interpret. Major centers like Cleveland Clinic and Johns Hopkins describe TEE as particularly
helpful for spotting blood clots, valve problems, infections such as endocarditis, and issues with the aorta.

Although TEE is considered an invasive test (because something goes inside your body), it’s not surgery.
It’s usually done with mild to moderate sedation, and most people go home the same day.

Why Your Doctor Might Order a TEE (Purpose & Indications)

A TEE isn’t ordered just for fun it’s used when doctors need a more detailed look to answer specific questions.
According to major cardiology guidelines and large heart centers, common reasons for a TEE include:

• Checking for blood clots in the heart, especially in the left atrial appendage.
  This is common in people with atrial fibrillation or after a stroke where doctors suspect a clot may have traveled from the heart.
• Evaluating heart valve problems, such as severe mitral regurgitation, prosthetic (artificial) valve function,
  or suspected valve infection (endocarditis).
• Looking for infections on the heart valves or lining (infective endocarditis), especially if blood cultures are positive
  or there are signs of infection that might have reached the heart.
• Assessing the aorta, particularly for tears (aortic dissection), aneurysms, or plaque that could cause emboli.
• Investigating unexplained strokes or mini-strokes (TIAs) when the doctor suspects a heart-related cause.
• Guiding procedures, such as closing a hole between heart chambers (like a PFO or ASD), placing certain devices,
  or helping surgeons during heart surgery to monitor function in real time.
• Clarifying uncertain findings from a standard transthoracic echocardiogram when images from the chest were unclear.

In short, TEE is the “zoom lens” of heart imaging: it’s used when doctors need sharper, more precise pictures to make decisions
about medicines, surgery, or other procedures.

How to Prepare for a TEE

Preparation for a transesophageal echocardiogram is usually simple, but it’s important to follow the instructions carefully
for safety and accurate results.

Fasting and food restrictions

• Most centers ask you not to eat or drink anything for about 6 hours before the test. This lowers your risk
  of vomiting or aspirating (breathing in) stomach contents while you’re sedated.
• You may be allowed small sips of water with essential medications, but only if your doctor or nurse says it’s okay.

Medications

Your care team will tell you which medications to take or hold before the procedure. In many cases:

• Blood pressure medicines are continued, but sometimes timing is adjusted.
• Blood thinners (anticoagulants) may be continued or briefly paused, depending on why you are having the TEE.
• If you have diabetes, your insulin or oral medications may need adjustment because of fasting.

Always follow your provider’s specific instructions and bring a list of all medications and supplements you take.

Other important details

• Allergies: Tell your team if you’ve ever had a reaction to sedatives, anesthetics, or latex.
• Dental issues: Let them know about loose teeth, dentures, or crowns to reduce the risk of damage.
• Medical conditions: Mention any esophageal problems (like severe reflux, strictures, varices), swallowing difficulties, or bleeding issues.
• Transportation: Because of sedation, you’ll usually need someone to drive you home afterward.

Step-by-Step: What Happens During a TEE Procedure

Knowing what to expect can make the procedure far less stressful. Here’s how a typical TEE goes from start to finish.

1. Check-in and pre-procedure prep

You’ll arrive at a hospital or outpatient clinic and check in. A nurse will review your medical history, medications, and consent forms.
You’ll change into a hospital gown and have an IV line placed in your arm for sedation.

Your heart rhythm, blood pressure, and oxygen levels are monitored throughout the test. You’ll lie on your left side on the exam table.

2. Throat numbing and sedation

To make the test more comfortable:

• Your throat will be sprayed with a local anesthetic to reduce gagging and discomfort.
• You’ll receive sedation through the IV. It usually makes you relaxed and drowsy; many people remember little or nothing of the procedure afterward.
• A bite block is placed in your mouth to protect your teeth and the probe.

3. Inserting the TEE probe

Once you’re drowsy and your throat is numb, the provider gently guides the flexible probe into your mouth. You’ll be asked to swallow as
it passes down your throat into the esophagus, similar to a swallowing motion when drinking water. This part can feel strange and may cause
a brief gag reflex, but it usually settles quickly.

4. Imaging your heart

When the probe is in position behind your heart, the real work begins:

• The transducer sends sound waves and receives echoes, creating moving images of your heart on a screen.
• The provider gently adjusts the probe’s position and angle to see different parts of your heart, including valves, chambers, and the aorta.
• Doppler techniques may be used to show blood flow and measure how well valves are opening and closing.

The imaging portion usually takes 15–30 minutes, although the total time in the procedure area is often longer because of prep and recovery.

5. Removing the probe and recovery

After enough images are obtained, the probe is carefully withdrawn. You’ll stay in a recovery area while the sedation wears off.
Your throat may feel sore or scratchy, and your voice might sound a little hoarse for a day or so.

Because of the throat numbing and sedation, you’ll be told not to eat or drink until your gag reflex returns (usually a couple of hours).
When cleared, you’ll start with sips of water and soft foods. Most people can go home the same day and resume normal activities the next day,
as long as they avoid driving or making big decisions until the sedation fully wears off.

Risks and Possible Complications of TEE

The good news: Large medical centers and professional societies consistently describe TEE as a low-risk procedure,
especially when performed by experienced teams. However, like any invasive test, there are potential complications you should know about.

Common, usually mild side effects

• Sore throat or hoarseness for a day or two.
• Mild discomfort in the neck or chest from the probe.
• Gagging sensation during insertion, even with numbing and sedation.
• Feeling drowsy or groggy for several hours after sedation.

Less common but more serious risks

• Bleeding or injury in the esophagus, including rare tears or perforation. This is more likely if you have pre-existing esophageal disease.
• Breathing or airway problems, such as low oxygen levels or laryngospasm, especially in people with lung disease or sleep apnea.
• Irregular heart rhythms during the procedure, usually brief and monitored closely.
• Dental or mouth injury, such as chipped teeth, particularly if teeth are already loose.
• Reaction to sedative medications, including low blood pressure, slowed breathing, or allergic reactions.

Because these complications are rare but important, your team will ask about your medical history, perform monitoring during the test,
and keep you in recovery until they’re sure you are stable.

After you go home, you should contact your healthcare provider or seek urgent care if you notice:

• Severe or worsening chest pain.
• Difficulty breathing or swallowing.
• Fever or chills.
• Vomiting blood or coughing up significant blood.

Understanding Your TEE Results

One of the top questions people have is, “When will I know what they found?” The timeline can vary:

• In some settings (for example, during surgery or emergency care), the cardiologist interprets the TEE in real time.
• In outpatient settings, images are often reviewed and a formal report is sent to your referring doctor within a few days,
  who then discusses the results with you.

A TEE report may comment on:

• Heart valves: Are they opening and closing properly? Is there leakage (regurgitation) or narrowing (stenosis)?
• Chambers and function: Are the heart chambers enlarged? Is the pumping function (ejection fraction) normal?
• Blood clots: Are there clots in the left atrium or left atrial appendage that could lead to stroke?
• Aorta: Is there evidence of aneurysm, dissection, or significant plaque?
• Holes or shunts: Is there a patent foramen ovale (PFO) or atrial septal defect (ASD) allowing blood to flow where it shouldn’t?
• Signs of infection: Are there vegetations (growths) on valves suggesting endocarditis?

Based on the results, your doctor may:

• Adjust medications (for example, start or change blood thinners, heart failure medicines, or antibiotics).
• Recommend another test (such as CT, MRI, or cardiac catheterization).
• Suggest a procedure or surgery (like valve repair, valve replacement, or closure of a heart defect).
• Decide that no immediate action is needed and continue monitoring over time.

If any part of the report is confusing, ask your cardiologist to walk you through the images and explain what it means in terms of your
symptoms, risks, and treatment options. You’re allowed and encouraged to ask questions until it makes sense.

TEE vs. Other Heart Imaging Tests

You might wonder, “Why not just use a regular echocardiogram, CT scan, or MRI?” Each test has strengths and limitations:

• Transthoracic echocardiogram (TTE): Noninvasive, done on the outside of the chest, no sedation needed. Great for most patients,
  but images may be limited by body habitus, lung disease, or certain anatomic positions.
• Transesophageal echocardiogram (TEE): Invasive and requires sedation, but provides much clearer views of the left atrium,
  valves, and thoracic aorta. Often used when TTE images are suboptimal or when high-precision detail is needed.
• Cardiac CT: Excellent for visualizing coronary arteries and aortic anatomy; uses X-ray radiation and contrast dye.
• Cardiac MRI: Great for detailed tissue characterization and function; takes longer and is not ideal for people with some implanted devices or severe claustrophobia.

Doctors choose the test or combination of tests that best answers the specific clinical question while balancing risks, comfort, and accuracy.

Questions to Ask Before and After a TEE

If you have a TEE scheduled, consider bringing these questions to your appointment:

• Why do I need a transesophageal echocardiogram instead of (or in addition to) a regular echocardiogram?
• What are you specifically looking for clots, valve issues, infection, or something else?
• What are my particular risks based on my other health conditions?
• How should I adjust my medications, especially blood thinners and diabetes medicines, before the test?
• Who will interpret the TEE, and when will I get the results?
• If you find something abnormal, what are the possible next steps?

Understanding the goal of the test and how it fits into your overall care plan can make the experience feel less like a mystery
and more like a purposeful, informed choice.

Real-Life Experiences With TEE: What It Feels Like

Reading about a procedure in clinical terms is one thing; living through it is another. While everyone’s experience is unique,
many people share similar themes: some nerves beforehand, a fuzzy memory of the actual test, and a lot of relief when it’s over.

Feeling anxious before the test

It’s completely normal to feel nervous when you hear the words “tube down your throat.” People often worry they’ll choke, panic,
or feel everything. In reality, the throat numbing spray and sedation do a lot of heavy lifting. Patients frequently report,
“I remember being in the room, and then I was waking up in recovery asking if we’d started yet.”

One practical tip people find helpful is to focus on the benefits rather than the discomfort. Knowing that a TEE can detect clots
that might cause a stroke, or clarify whether a valve needs repair, often makes the short, strange experience feel worthwhile.
Some also find comfort in bringing a trusted family member or friend for support before and after the procedure.

During the procedure: the “foggy” part

Once sedation kicks in, time tends to blur. You might vaguely remember someone asking you to swallow or turn slightly, but the
majority of the test usually feels like a brief nap. The care team continuously monitors your breathing and heart rhythm, and
they’re trained to react quickly if you’re uncomfortable or your vital signs change.

Many people later describe the TEE as “less dramatic than I imagined” more like a longer-than-usual dentist visit, but
with better pillows and fewer magazines.

Right after the TEE: sore throat, big relief

Afterward, it’s common to feel groggy and a bit wobbly when standing. Your throat may feel scratchy, and swallowing might be
mildly uncomfortable the first day. Warm tea, cool drinks, or soft foods often help. Most people return to their usual routine
the following day, with the main limitation being “no driving and no signing any major contracts” until the sedative fully wears off.

Emotionally, there’s often a sense of relief: relief that the test is over, and relief that your care team now has clearer
information. For people who’ve had unexplained strokes, recurrent infections, or puzzling symptoms, the TEE can provide answers
that change treatment like starting or stopping blood thinners, scheduling valve surgery, or ruling out an aortic problem.

Caregivers’ and family perspectives

Loved ones watching from the waiting area may feel more anxious than the person having the test. They often worry about sedation
or complications. Having clear expectations from the medical team including how long the procedure takes, what recovery looks like,
and when they can see their family member again can reduce that stress. Caregivers also play an important role in helping with
transportation, monitoring for any unusual symptoms afterward, and remembering the details of the doctor’s explanation when results are reviewed.

Using the information to move forward

The real “experience” of a TEE doesn’t end in the recovery room. Its impact continues as you and your healthcare team decide what to do
with the new information. For some, that might mean scheduling a valve repair, starting antibiotics, or continuing long-term blood thinners.
For others, it may simply confirm that current treatment is working well.

While no test is completely risk-free, a transesophageal echocardiogram is a powerful tool that often guides life-saving or
stroke-preventing decisions. Taking the time to understand the purpose, procedure, risks, and results and hearing about real-world
experiences can make it easier to face the test with confidence rather than fear.

Bottom Line

A transesophageal echocardiogram (TEE) is more than just a fancy ultrasound; it’s a detailed, behind-the-scenes look at your heart
that can reveal problems a standard echocardiogram might miss. Although it involves sedation and placing a probe in your esophagus,
it’s generally safe, short, and extremely informative. If your doctor recommends a TEE, it’s because the extra detail it provides
can directly shape your care from preventing strokes to planning valve surgery or confirming that your heart is working as it should.

Ask questions, follow the preparation instructions, and give yourself permission to feel a bit anxious. You’re not alone in that.
With an experienced team and a clear understanding of what to expect, a TEE is usually less intimidating than it sounds and often
well worth the temporary discomfort for the long-term benefits to your heart health.