Trans-oesophageal echocardiography

Why is a TOE prescribed?

This specialised procedure investigates the heart – valves, walls, cavities – and the thoracic aorta using the same techniques as a trans-thoracic echocardiogram, using an ultra-sound probe.

This tiny probe is fitted to an endoscope (the kind usually used to collect images of your oesophagus or stomach). This is an ideal way of collecting images of the heart since the oesophagus (through which the probe is inserted) is in direct contact with the heart: consequently the images obtained are of very high quality, which is not always the case for trans-thoracic echocardiogram.

The ultra-sound waves are reflected back by the structure of the heart and analysed by the ultra-sound imaging apparatus which then produces images of the heart structure in movement.

A trans-thoracic echocardiogram usually precedes the trans-oesophageal echocardiogram: the two procedures provide complementary information.

The trans-oesophageal echocardiogram provides a means of obtaining images of the heart, aorta and, most importantly, the smaller structures within the heart which are often invisible to not only a trans-thoracic electrocardiogram but also to many other radiological imaging techniques (such as scanners).

Indications

After a stroke or any other form of peripheral arterial embolism, locating a blood clot inside the heart is an important signifier, particularly when the heart rate is irregular (in atrial fibrillation or “total arrhythmia”).

Finding a structural anomaly in the heart valves or a functional anomaly in a heart implant is a frequent signifier.

The Trans-oesophageal echocardiogram is a precious resource for diagnosing cases of suspected infectious endocarditis, the location of valve growths and/or mutilation caused by pathogenic germs in the blood (septicaemia).

The thoracic aorta, the large blood vessel linking the heart with most of the organs is also examined to locate any anomalies on its walls (atheroma plaques, clots, tears, etc.).

Other indications raised during consultations or examination may also justify the need for a trans-oesophageal echocardiogram. For more information ask the doctor who prescribed the procedure.

The trans-oesophageal echocardiogram procedure in detail

Preparation

You will be asked not to eat or drink for at least 4 hours before the examination. Any medication should be taken with as little water as possible and as much in advance as possible. In most cases you will be able to make your own way to the ultrasonography laboratory. If you are hospitalised you will be taken there by an orderly in a wheel chair or bed.
An intravenous drip will be inserted into a vein in your arm to administer, where necessary, a sedative or a physiological serum in order to identify an unusual blood passage inside the heart (contrast ultrasonography). In this case the doctor will explain in great detail when the injection will take place to ensure the best possible tolerance and interpretation.

Location for the procedure

At the echocardiography laboratory, in an echocardiography room with an intake, oxygenation system and a trolley with any emergency medication which may be necessary.

The duration of the procedure

The procedure takes 15 to 25 minutes, except in specific circumstances.

A trans-thoracic echocardiogram will be completed beforehand which will lengthen the process (45 to 60 minutes). In most cases the probe will not remain inside the digestive tract for more than 15 minutes.

The procedure methods

On arrival you will be asked a number of questions to ensure there are no contraindications which may affect the procedure: no irradiation of the thorax, no known oesophageal condition. You will be asked to remove any removable dental appliances and or your glasses to avoid damaging them. You will also be asked if you have any known allergies to anaesthetics (lidocaine).
A local anaesthetic will be sprayed on the back of your throat to ensure that the probe passes painlessly. In certain cases a sedative will be injected intravenously providing there are no contraindications for this, this will calm any apprehensions and help you to remain calm during the procedure (this will be a simple “hypno-induction” and not a general anaesthetic).

After the procedure

For a quarter of an hour or so after the procedure, you may feel some pain at the back of a throat, similar to a common sore throat. You should refrain from eating for a further hour after the end of the procedure since the anaesthetic spray applied to the back of the throat may cause you food or drink to go down the wrong way. If you have received medication through an intravenous drip you will remain under observation by a nurse for an hour and you should also refrain from driving for the rest of the day.

On your arrival at the echocardiography laboratory and reception by its nursing staff do not hesitate to ask any questions.

Potential risks:

Benign effects such as minor digestive problems or palpitations may occur.

More serious complications are extremely rare (perforation of the digestive tract in 0.02 to 0.03% of cases, most often in patients with oesophageal conditions; death in 0.01% of cases).

The benefits of this procedure:

The data collected can be used to confirm or eliminate a suspected diagnostic (valve infection, blood clot, aorta problem, permeability of the wall between the two atria, etc.), to evaluate the severity of a condition affecting the valves (native or prosthetic), or to provide guidance for certain therapeutic decisions.

Practical information

Dr Coraline CHALARD, Cardiologist, Ex-Paris Hospital Intern, DIU echocardiography, specialist in cardiac insufficiency and oncocardiology.

Dr Clémence DARRORT, Cardiologist, Ex-Paris Hospital Intern – Ex-Assistant Clinic Head.

Dr Camille DEGUILLARD, Cardiologist, Ex-Paris Hospital Intern, DIU echocardiography, DIU Sports Cardiology

Dr Dominique de ZUTTERE, Cardiologist, Paris Hospital Practitioner, member of the French Cardiology Association and holder of the “Diplôme Interuniversitaire d’Échocardiographie d’Île-de-France.”

Dr Rith SAN, Cardiologist, Ex-Paris Hospital Intern, DIU echocardiography, DIU of cardiac imagery, coroscanner and myocardial MRI.

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