Transesophageal echocardiography

Transesophageal cardiac ultrasound, or transesophageal echocardiography, helps examine cardiac structures and assess cardiac function in greater detail than is possible with standard ultrasound.

Transesophageal echocardiography is considered to be a rather informative diagnostic procedure, during which the transducer is placed in the area of the esophagus, which allows you to get as close as possible to the heart and examine it smoothly. During the examination, the doctor gets a clear picture of the structure of the organ, including myocardium and valve system, identifies neoplasms and thrombi inside the heart chambers.

Indications for the procedure

Transesophageal echocardiography has a number of advantages over other similar techniques:

• The transducer is passed into the esophagus, without any serious obstacles on its way, which allows you to get more accurate information, a clear picture, for the subsequent correct determination of the state of the heart;
• It is much easier to assess the cardiac apparatus in patients with congenital anomalies and malformations, as well as problems with the valve system after prosthetics;
• It is possible to easily and reliably diagnose thrombus formation and tumors in the heart area.

Transesophageal echocardiography is used in the following situations:

• to clarify information obtained during a routine cardiac ultrasound examination - in particular, when questions arise as part of the diagnosis;
• in suspected malformations of acquired or congenital nature, endocarditis, tumors or blood clots, aortic abnormalities;
• To evaluate the quality of heart valve implant performance after prosthetic implantation;
• to identify the source of embolism in ischemic or stroke conditions;
• to identify atrial clots in patients with atrial fibrillation rhythm disturbances for subsequent restoration of normal cardiac function.

In children, transesophageal echocardiography is indicated for the diagnosis of congenital heart defects, for perioperative examination, cardiac catheterization, and postoperative follow-up.

Transesophageal manipulation is prescribed in cases where other techniques cannot be applied due to acoustic obstacles in the direction of ultrasound flow. In particular, the interference may be rib bones, muscles, lungs, cardiac implants. If the transducer is inserted into the esophagus, such obstacles are no longer a problem for it, because it is adjacent to the esophageal tube to the left atrium and descending aortic section. As a result, atrial and intracameral thrombi, malformations, and vegetations are easily detected with transesophageal echocardiography, although this type of examination is technically more difficult.

Preparation

The entire preparatory phase and the transesophageal echocardiography procedure together take approximately 2 hours.

Preparation Highlights:

• EchoCG is performed on an empty stomach. This means that the last meal should take place no earlier than 7-8 hours before the examination. Drinking regular drinking water without gas is allowed no later than two hours before the procedure. Then you can also drink medications, if they have been prescribed by a doctor (taking any medications on your own is strictly contraindicated).
• Transesophageal manipulation is usually performed after pre-sedation in the presence of an anesthesiologist.
• If general anesthesia is planned, it is important to take care in advance about who will accompany the patient after the procedure: driving a car for a day after general anesthesia is not recommended.
• If the patient has an allergic reaction to any medication or has had esophageal or/and stomach problems, the doctor should be notified.
• It is mandatory to remove removable dental implants before the study.

Details of the procedure of transesophageal echocardiography should be checked in advance with your doctor: individual recommendations are possible.

Technique of the transesophageal echocardiography

Upon completion of all preparatory manipulations, the attending physician explains and describes in detail how the transesophageal echocardiography is performed. After receiving recommendations from the doctor and anesthesiologist, the patient removes glasses (lenses), removable dentures, jewelry. He is laid on the left side, connected to the electrocardiograph, provide venous access (if there is a need to administer drugs).

A special mouthpiece is placed between the patient's teeth to prevent accidental damage to the probe tube. Next, the technician helps the subject swallow the probe.

In most cases, non-intensive local anesthesia is used by irrigation of the oral cavity and posterior pharyngeal wall (lidocaine spray is most commonly applied).

The immediate duration of manipulation without the preparatory stage is about 15 minutes.

In order to minimize discomfort, the patient is advised to remain calm, breathe slowly and steadily, while relaxing the neck and shoulder muscles.

When inserting the probe, it is important to realize that the tube is not inserted into the respiratory system, but into the esophagus, so it will not interfere with normal respiratory function. Breathing should be done through the nose.

During the entire diagnostic process, the specialist constantly records electrocardiography, monitors blood pressure, saturation. If suspicious changes are detected in any indicators, manipulations are interrupted.

Upon completion of the procedure of transesophageal echocardiography, the patient is offered to rest for about half an hour, after which he can go home (preferably accompanied by someone close to him).

Transesophageal stress echocardiography is a combination of two-dimensional echocardiography with stress tests. In particular, it is possible to use bicycle ergometry (vertical, horizontal), treadmill test, stimulation with pharmacological agents, electrical stimulation.

If it is supposed to be combined with bicycle ergometry, the subject is undressed to the waist and asked to sit on the simulator. At the same time, electrodes are applied to take ECG readings and a blood pressure cuff is put on. The specialist sets the initial load, determining and evaluating the work of the heart. The stay of the sensor in the esophagus at this time usually does not exceed 8-10 minutes. Stress echocardiography with transesophageal electrical stimulation may be prescribed if conventional echocardiography is not informative enough or cannot be performed for any reason (e.g., obesity).

In contrast to adults, for whom the examination is performed in an outpatient clinic using local anesthetic, in children transesophageal echocardiography under anesthesia is more often performed. This procedure requires hospitalization of the child.

Contraindications to the procedure

Before prescribing a transesophageal echocardiography, the doctor makes sure to check if the patient has any contraindications to the procedure, such as:

• uncontrolled hypertension;
• lesions, bleeding in the stomach and/or esophagus;
• of tumors in the esophagus;
• swallowing reflex disorders;
• perforating injuries to internal organs;
• esophageal varices;
• esophageal diverticula.

The procedure is being denied to patients:

• with acute inflammatory processes in the gastrointestinal tract;
• with a tendency to vomit, strong gag reflex;
• with certain mental disabilities.

As can be seen, some contraindications are relative. In such cases, the examination of transesophageal echocardiography is not canceled, but postponed until the contraindication is eliminated. Individual patients are selected another diagnostic technique according to individual indications.

Complications after the procedure

Feelings after transesophageal echocardiography can be somewhat unpleasant: many patients have a sore or sore throat for several hours, nausea may occur.

During the day, the subject is not recommended to drive a car, as the use of sedatives and anesthetics can provoke some drowsiness.

In addition, the possibility of mechanical damage (irritation) to the throat and esophagus cannot be ruled out. This is why the procedure should not be performed on patients with various diseases of the esophagus, including varicose veins.

The subject should always inform the physician if they have any:

• infectious diseases;
• allergies to anything (allergies to medicines are always specified);
• glaucoma;
• respiratory illnesses;
• liver disease;
• swallowing problems.

It is mandatory to indicate if the person has previously undergone any surgical interventions on the digestive organs.

Complications are very rare. The doctor should be consulted immediately if the following symptoms are detected after transesophageal echocardiography:

• severe or increasing pain, trouble swallowing;
• abdominal pain, chest tightness;
• vomiting (brown, "coffee", bloody mass).

In isolated cases after transesophageal manipulations were fixed:

• traumatic injuries to the trachea, pharynx;
• esophageal venous bleeding;
• esophageal perforation;
• a transient type of bacteremia;
• hemodynamic disorders;
• heart rhythm malfunctions.

Overall, transesophageal echocardiography is a semi-invasive examination with an extremely low risk of complications.

Care after the procedure

After manipulations in the framework of transesophageal echocardiography, patients go home after a short rest (about 30 minutes, if general anesthesia was not used).

Eating is allowed under the conditions of restoration of the swallowing reflex and after the disappearance of numbness of the throat. Food should be light, soft or liquid, slightly warm. It is also recommended to drink a sufficient amount of normal warm water.

Allowed foods:

• porridge, pureed soups;
• pureed boiled vegetables, pates;
• sugar-free herbal teas.

The first portions of food after diagnosis should not be large (up to 150-200 g).

After transesophageal manipulations, you should not drive a car for 24 hours. It is advisable to avoid physical exertion, do not consume hard, hot, sour and spicy food (it is recommended to "postpone" the first meal for 1-2 hours). Coffee, alcohol, carbonated drinks, spices, fatty foods are forbidden.

Medications should not be taken immediately after diagnosis: if regular medication is necessary, you should consult your physician.

Transesophageal echocardiography provides specialists with much more reliable information than conventional cardiac ultrasound, but also has its own specifics of conduction and recovery.