Transoesophageal Echocardiography (TOE)

Transoesophageal echocardiography (TOE) is a medical imaging procedure used to produce images of the heart and its blood vessels from within the esophagus. This technique provides high-quality images of the heart's structures, allowing for accurate diagnosis and monitoring of various cardiac conditions.

Indications

• Evaluation of cardiac structure and function in patients with suspected or known heart disease
• Assessment of valve function and morphology
• Diagnosis of endocarditis, cardiac tumors, and thrombi
• Guidance during percutaneous interventions, such as transcatheter aortic valve replacement (TAVR) or atrial septal defect closure
• Monitoring of patients undergoing cardiac surgery

Procedure

The TOE procedure involves the insertion of a flexible tube (endoscope) with an ultrasound probe on its tip through the mouth and into the esophagus. The endoscope is guided to the level of the heart, where the ultrasound probe emits high-frequency sound waves that bounce off the heart's structures, producing images.

The procedure typically takes 30-60 minutes to complete and may be performed under local anesthesia or conscious sedation. Patients are usually required to fast for several hours before the procedure and may need to stop taking certain medications beforehand.

Benefits

• High-resolution images of the heart's structures, allowing for accurate diagnosis and monitoring
• Ability to evaluate cardiac function in real-time
• Guidance during percutaneous interventions, reducing the risk of complications
• Minimally invasive procedure with low risk of complications

Risks and Complications

While TOE is generally a safe procedure, there are potential risks and complications to consider:

• Oesophageal perforation or bleeding
• Dental or oral trauma
• Gagging or choking
• Allergic reactions to sedatives or local anesthetics
• Cardiac complications, such as arrhythmias or hypotension

Contraindications

The following conditions may contraindicate the use of TOE:

• Oesophageal stricture or obstruction
• Active bleeding or coagulopathy
• Pregnancy (unless absolutely necessary)
• Previous oesophageal surgery or radiation therapy

Interpretation of Results

The images obtained during TOE are interpreted by a trained cardiologist or echocardiographer. The results may be used to:

• Diagnose cardiac conditions, such as valve disease or cardiac tumors
• Monitor cardiac function and response to treatment
• Guide percutaneous interventions or surgical procedures

Frequently Asked Questions (FAQs)

What is Transoesophageal echocardiography?
An ultrasound test using a tube inserted through the mouth into the esophagus to view the heart.

Why is Transoesophageal echocardiography performed?
To evaluate heart structure and function, especially for heart valve problems or before surgery.

How is the procedure done?
A flexible tube with an ultrasound probe is inserted through the mouth into the esophagus.

Is the procedure painful?
Typically not, as it's done under sedation and local anesthesia.

What are the risks of Transoesophageal echocardiography?
Bleeding, infection, or damage to the esophagus or teeth.

How long does the procedure take?
About 30-60 minutes.

Can anyone have a Transoesophageal echocardiography?
Most people, but not those with certain esophageal conditions or severe gag reflex.

Do I need to prepare for the test?
Yes, by fasting for several hours beforehand.

Will I be awake during the procedure?
Partially, as you'll be under sedation but able to follow instructions.

When can I go back to normal activities after the test?
Usually within a few hours, once the sedation wears off.