TransesophagealEchocardiogram(TEE)
Atransesophagealechocardiogramisaspecialtypeofechocardiogram(ultrasoundoftheheart). Thistestusesaspecialechocardiographytransducer(ultrasoundcamera)thatisinsertedthroughyourchild'smouth,throughthebackofthe
throat,andintotheesophagus(Figure1)orfeedingtubebetweenmouthandstomach.Itisverysimilartothescopeusedforupperendoscopybygastroenterologists.
ATEEisperformedwhenthestandardechocardiogramisn’tclear
enoughtomakethesuspecteddiagnosis.It’salsoperformedinpatientswhoarehavingheartsurgerytogivethesurgeonandanesthesiateammoreinformationtoguidetreatmentafter
surgeryandconfirmthatthesurgicalprocedurehasbeensuccessfulorifadditionalrepairisneededpriortoleavingtheoperatingroom.TheriskofaTEEisminimalandyourcardiologistwilldiscusswithyouthereasonsyouneedaTEEaswellasstandardechocardiography.
Therearetwomainadvantagesofthistypeofechocardiogram.First,itallowsyourcardiologisttogetamuchbetterlookatsomeoftheheartstructures,includingthewallbetweenthetwotopchambersoftheheart(atrialseptum)andheartvalves.Thisisbecausetheesophagusandstomachareveryclosetotheheart(Figure2)andmayallowthecardiologisttoobtainmoredetailedpicturesoftheheartcomparedtoroutineechocardiogramsperformedfromthechestwall.Secondly,itallowsthecardiologisttoobtainimagesoftheheartduringheartprocedures(surgeryandcardiaccatheterization)withouthavingtheechocameragetinthewayoftheprocedure.
Thisproceduremaycausediscomfortandgaggingifdonewithoutsedation.Forthisreason,transesophagealechocardiogramsinchildrenarealwaysperformedwithsometypeofanesthesia.Yourchildwilleitherundergogeneralanesthesiaorbeheavilysedatedwithintravenousmedication.Amemberoftheanesthesiateammayspraymedicineinthebackofyourchild'sthroattomakeitfeelsomewhatnumb.Duringtheprocedureyourchild'sbreathingandvitalsignswillbemonitoredveryclosely.Thetypeofanesthesiawilldependontheageofyourchild,reasonforhavingthestudyperformed,yourchild'soverallhealthstatus,andpreferencesofthemedicalteam.
Yourdoctormayrecommendatransesophagealechocardiogramforseveralreasons.Themostcommonistoprovideadditionalinformationduringheartsurgeryorcardiaccatheterization.In
thesecases,yourchildwillalreadybeunderanesthesiaorheavysedationfortheprocedureitself.Otherindicationsincludetryingtofindapossiblereasonforastroke,tryingtofindasmallholebetweentheupperchambersoftheheartthataregularechocardiogramcouldnotsee,makingsuretherearenobloodclotsintheheartinchildrenwithabnormallyfastheartrhythms,lookingforinfectionsintheheart,checkingthatartificialvalvesareworkingproperly,andmakingsurethatthewalloftheaorta(mainbloodvesseltothebodyisnotdamaged).Someconditionswouldleadtoyourcardiologistrecommendingagainsttransesophagealechocardiographysuchasseverenarrowingoftheesophagusorstomach.
Theprocedureusuallytakes20to40minutes,butthetotaltimewithsedationisusually60to
90minutes.Ifyourchildisanoutpatient,heorsheshouldbeabletogohometwotothreehoursaftertheprocedure.Theprocedureisverysafe.Yourdoctorwillgoovertherisksofthe
procedurewithyouandgiveyouanopportunitytoaskquestionspriortothetest.Somechildren
complainofasorethroatforafewhoursandmayhaveanupsetstomachfromtheanesthesia.Almosteveryonecanreturntonormalactivitywithin24hours.