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?
It is an ultrasound imaging procedure used to produce images of the heart.

Why is Transoesophageal echocardiography performed?
To evaluate heart structure and function, typically for patients with certain heart conditions or before surgery.

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

Is Transoesophageal echocardiography painful?
Generally not, but may cause mild discomfort or gagging sensation.

Are there risks associated with Transoesophageal echocardiography?
Potential risks include bleeding, infection, and damage to the esophagus or teeth.

How long does Transoesophageal echocardiography take?
Typically around 30 minutes to an hour.

Do patients need to be sedated for Transoesophageal echocardiography?
Often yes, to help relax and reduce discomfort during the procedure.

Can patients eat before Transoesophageal echocardiography?
Usually no, fasting is required for several hours before the procedure.

Are the results of Transoesophageal echocardiography available immediately?
Typically yes, but may require interpretation by a cardiologist or radiologist.

Is Transoesophageal echocardiography suitable for all patients?
Not always, certain conditions or factors may make it unsuitable or require special precautions.