A transoesophageal echocardiogram (TOE) is a procedure which allows a cardiologist to view images of your heart. It involves inserting a probe on the end of a flexible scope into the oesophagus (the food pipe connecting the mouth to the stomach).

The oesophagus lies directly behind the heart, so images are much clearer than those from the front of the chest (transthoracic echo) where the chest wall, ribs and lungs get in the way.

The images obtained assist the medical team in making a diagnosis as they show the condition of the heart and valves in detail. The findings can often help guide future treatment plans.

Preparing for the TOE procedure

• You should not eat for at least six hours or take fluids up to four hours before the procedure. This includes water except for taking tablets.
• Take any morning medication required with as little water as possible unless told otherwise by a healthcare professional.
• If you take anticoagulants (medication to thin the blood) such as warfarin, edoxaban, apixaban, rivaroxaban etc, you may require to stop takingthese before the TOE. Patients taking warfarin, may also require a blood test to check how thin their blood is to reduce any chance of bleeding. You should be told when to stop taking these medications by a heart specialist however please phone the Cardiology Department on 01324 567232, in advance, if you are unclear about the timing.
• You should go to the Cardiology Day Unit where you will be prepared for the procedure.
• Please inform staff of any allergies, swallowing difficulties, mouth, gullet or stomach problems, including previous surgery.
• Dentures should be removed before the procedure and please tell a member of staff about any caps or crowns you may have.
• If the procedure is being undertaken as an outpatient or you are going home afterwards, arrange for someone else to drive you home as sedation is given during the test. It is recommended that you arrange for someone to stay overnight with you.

How long does it take?

If you are an outpatient, you should plan to be in the hospital for at least three to four hours. The procedure can last from 10 to 30 minutes. The remainder of the time is spent on preparation, observation and recovery. If you are having the procedure whilst an inpatient, you may return to the ward whilst still drowsy.

What does the procedure involve?

A small cannula (venflon) will be placed into a vein in your arm so that the sedation can be given before you are asked to swallow the ultrasound probe. Your throat will be sprayed with local anaesthetic. You will be asked to lie on your left side. A guard will be placed between your teeth as a protection from biting while you are sedated. You will be attached to a heart monitor and a probe will be clipped to your finger to observe oxygen levels. A small sponge will be placed in your nostril to provide oxygen during the procedure.

How safe is the procedure?

The procedure is very safe and complications are rare. On occasions patients may experience breathing problems, abnormal or slow heart rhythm/reaction to the sedative or minor bleeding. It is very important that you inform the staff of any adverse reactions to previous sedation or anaesthetic. These complications are rare and in most cases the procedure causes no distress. If you think you are experiencing bleeding, persistent pain or fever please inform a healthcare professional.

In rare cases, the oesophagus may tear or rupture – however this happens in less than 1 in 1000 patients. The procedure will be explained to you at the hospital and you will have the opportunity to ask questions before signing a consent form. Consent is when you have a choice of whether to accept treatment or investigations. You are free to say no or to ask for more information.

Recovering after the procedure

You should not drive for at least 24 hours after the procedure because the sedative can have a hangover effect. Although you may feel fine, your reasoning, reflexes, judgement, coordination and skills can all be affected by having sedation. So, until the next day after the procedure please do not:

• Drive any vehicle, including riding a bicycle.
• Operate any machinery.
• Attempt to cook, use sharp utensils or pour boiling fluids.
• Drink alcohol.
• Make any important decisions or sign any contracts.

When will I receive the results?

The images may take some time to analyse and are often reviewed with other specialists; therefore you will therefore not receive any results on the day of the procedure. A report of your results will be sent to your referring healthcare professional, and you will be contacted by letter, phone, or if necessary, given an appointment.

If you are an inpatient, you may be back in the ward before you are informed of the results. This can often be because you are still drowsy and unable to remember any discussion because of the sedation.