Trans-oesophageal Echocardiogram (TOE)

A trans-oesophageal echocardiogram (TOE) is a medical imaging test that uses high-frequency sound waves to produce images of the heart and its blood vessels. The test involves inserting a flexible tube with an ultrasound probe on the end through the mouth and into the oesophagus, which lies behind the heart.

Why is TOE performed?

A TOE may be performed for several reasons, including:

• To evaluate the structure and function of the heart valves
• To assess the presence and severity of heart valve disease
• To diagnose and monitor conditions such as endocarditis (infection of the heart valves) or cardiac tumours
• To guide certain medical procedures, such as catheter ablation or percutaneous valve repair
• To evaluate the effectiveness of treatments for heart conditions

How is TOE performed?

The test is typically performed in a hospital or outpatient setting by a cardiologist or other trained medical professional. The procedure involves:

1. The patient is given a local anaesthetic to numb the throat and a sedative to help them relax
2. A flexible tube (endoscope) with an ultrasound probe on the end is inserted through the mouth and into the oesophagus
3. The ultrasound probe emits high-frequency sound waves that bounce off the heart and its blood vessels, producing images on a monitor
4. The doctor or technician manipulates the endoscope to obtain images of different parts of the heart from various angles
5. The test typically takes 30-60 minutes to complete

Risks and complications

While TOE is generally a safe procedure, there are some potential risks and complications, including:

• Bleeding or perforation of the oesophagus (rare)
• Dental or mouth injuries from the endoscope
• Gagging or discomfort during the procedure
• Allergic reactions to the sedative or anaesthetic

Preparation and aftercare

To prepare for a TOE, patients should:

• Avoid eating or drinking for several hours before the test
• Remove any dentures or oral appliances
• Inform their doctor about any medications they are taking

After the test, patients may experience:

• A sore throat or mouth
• Numbness or discomfort in the throat (temporary)
• Drowsiness from the sedative ( temporary)

Interpretation of results

The images obtained during a TOE are interpreted by a cardiologist or other trained medical professional. The results may show:

• Abnormalities in heart valve structure or function
• Presence of blood clots or tumours
• Enlargement or thickening of the heart muscle
• Other conditions affecting the heart and its blood vessels

The results of a TOE are used to diagnose and manage various heart conditions, and may be combined with other diagnostic tests, such as electrocardiogram (ECG) or cardiac catheterization.