Transesophageal Echocardiography (TEE)

Heart Institute at UPMC Children’s Hospital of Pittsburgh

Transesophageal echocardiography, also known as TEE, is an echocardiogram made using endoscopy. A small probe is guided through the throat into the esophagus while a child is sedated to closely evaluate the heart and blood vessels within the chest.

TEE is used to evaluate the internal heart structures and path of blood flow in congenital (present at birth) heart defects. TEE is also used during heart surgery to evaluate the effects of surgical intervention to the heart, such as repair of congenital heart defects.

TEE may be a more appropriate type of echocardiogram when circumstances that may interfere with the ability to obtain adequate images—such as pulmonary disease—are present. Certain conditions of the heart, such as mitral valve disease, blood clots or masses inside the heart, dissection (tear) of the lining of the aorta, and implanted heart valves also may be more easily seen and assessed with TEE than with regular echocardiograms.

Echocardiography uses sound waves to assess the heart's function and structures. A transducer (similar to a tiny microphone) sends out ultrasound waves at a frequency too high to be heard. When the transducer is placed at certain locations and angles, the ultrasound waves move through the skin and other body tissues to the heart tissues, where the waves "echo" off of the heart structures. The transducer picks up the reflected waves and sends them to a computer. The computer interprets the echoes into an image of the heart walls and valves.

The TEE transducer works the same as the one used in a regular echocardiogram, but because the sound waves do not have to pass through skin, muscle, or bone, a clearer image of the heart can be obtained.

There are several different types of TEE echocardiography. A TEE can utilize one, or more, of four special types of echocardiography:

• M-mode echocardiography is the simplest type of echocardiography, and produces an image similar to a EKG tracing rather than an actual picture of heart structures. M-mode echo is useful for measuring heart structures, such as the heart's pumping chambers, the size of the heart itself, and the thickness of the heart walls.
• Doppler echocardiography is used to measure and assess the flow of blood through the heart's chambers and valves. The amount of blood pumped out with each beat is an indication of how the heart is functioning. It also can detect abnormal blood flow within the heart, which can indicate such problems as an opening between chambers of the heart, a problem with one or more of the heart's four valves, or a problem with the heart's walls.
• Color Doppler is an enhanced form of Doppler echocardiography. With color Doppler, different colors are used to designate the direction of blood flow. This simplifies the interpretation of the Doppler technique.
• 2-D (2-dimensional) echocardiography is used to "see" the actual structures and motion of the heart structures. A 2-D echo view appears cone-shaped on the monitor, and the real-time motion of the heart's structures can be observed, enabling the doctor to see and evaluate the various heart structures at work. Depending on the results of the TEE, additional tests or procedures may be scheduled to gather further diagnostic information.

View the patient procedure sheet about TEE at UPMC Children’s Hospital of Pittsburgh.