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Procedures

Transoesophageal echocardiogram (TOE)

Why has my cardiologist recommended a Transoesophageal echocardiogram (TOE)?

Your heart is made up of four chambers separated by valves and walls. A TOE provides your cardiologist with a different view of these structures compared to a standard echocardiogram and is particularly useful when:

  • Your cardiologist believes you have a problem with one of your valves or you are being assessed for a suitable valve repair or replacement management plan
  • You are being investigated for a suspected infection, growth or tumour
  • You may be having a procedure that requires your cardiologist to close a hole in one of the walls of your heart or insert a cardiac device in the heart for other reasons.
  • You are having a cardioversion (shock to the heart) for an arrhythmia and your cardiologist wants to ensure you do not have a blood clot in one of the chambers of your heart before proceeding.

Transoesophageal echocardiogram (TOE) is a diagnostic procedure that uses ultrasound waves to study the structure and function of your heart.

What is a Transoesophageal echocardiogram (TOE)?

A transoesophageal echocardiogram or TOE is where an ultrasound probe is inserted into the oesophagus (the pipe connecting your mouth to your stomach), via the mouth, to take images of the structure of your heart. Placement of the probe within the oesophagus allows close up images of your heart valves and chambers, removing the interference that the lungs and ribs can cause during a standard echo, and therefore allow clearer more detailed images of the heart, and to visualise parts of the heart that cannot usually be seen in a standard echocardiogram.

Why have I been referred to a different cardiologist for this procedure?

Your heart is made up of four chambers separated by valves and walls. A TOE provides your cardiologist with a different view of these structures compared to a standard echocardiogram and is particularly useful when:

  • Your cardiologist believes you have a problem with one of your valves or you are being assessed for a suitable valve repair or replacement management plan
  • You are being investigated for a suspected infection, growth or tumour
  • You may be having a procedure that requires your cardiologist to close a hole in one of the walls of your heart or insert a cardiac device in the heart for other reasons.
  • You are having a cardioversion (shock to the heart) for an arrhythmia and your cardiologist wants to ensure you do not have a blood clot in one of the chambers of your heart before proceeding.

What should I expect during a Transoesophageal echocardiogram (TOE)?

At Western Cardiology all our procedures take place at St John of God Hospital in Subiaco. The procedure will usually take place in the specialised Coronary Care Unit.
To ensure the procedure is comfortable you will be administered sedation by vein to place you in a state of sleep and unawareness. This may be administered by the cardiologist or by a specialist anaesthetist. Additionally, you may receive a spray of local anaesthetic into the back of the throat to numb the area and suppress the gag reflex.
You will be attached to standard cardiac monitoring equipment.
Your cardiologist will then:

  • Ask you to lie on your left side on the bed.
  • Place a small plastic guard on your mouth to protect your teeth and to stop you biting down on the tube.
  • Once you are sedated a thin, lubricated endoscopy tube will be passed into your throat and down your oesophagus. This part of the procedure is brief but may feel transiently uncomfortable. It won’t interfere with your breathing. If you are still partially awake you may be asked to swallow to assist in the tube moving into position.
  • Position the probe and take the required pictures of your heart. You will not feel anything during this part of the procedure.
  • Remove the tube.

The imaging part of the procedure will generally take less than 15 mins.

How should I prepare for a Transoesophageal echocardiogram (TOE)?

We ask that you discuss any previous problems or abnormalities of your oesophagus with your cardiologist, such as a hiatus hernia, previous swallowing difficulties or cancer.

Before the day of the procedure, please register with St John of God Subiaco Hospital admissions at www.sjog.org.au/myadmission and complete the online Admissions Form and follow their instructions. If you require any assistance please call 1300 863 566.

On the day of your procedure please bring in your Medicare card, private insurance details, and all your current medications. You will have receive further details about where to present to on the day.

Do not eat or drink for six hours prior to your procedure. If you need to take your regular medication in the fasting period please take with small sips of water. If you are taking blood thinners it is important to continue to take these, especially if a cardioversion is planned.

What are the risks associated with a Transoesophageal echocardiogram (TOE)?

A TOE is a common procedure, performed by one of our highly trained diagnostic imaging cardiologists. It is generally considered a low risk procedure.
All medical procedures can however carry a small level of risk. Most commonly with a TOE you may experience some soreness throat or mouth following the procedure that is mild and short-lived.
Uncommonly a TOE may be associated with:

  • Damage to your teeth or jaw
  • Bruising or a tear of the oesophagus

Very rarely a TOE may be associated with:

  • Perforated oesophagus requiring surgery to repair
  • Breathing or respiratory problems
  • Death is extremely rare

Your individual risks will be discussed by your cardiologist before the procedure. They will depend on your age, your other medical conditions and other factors.

Aftercare requirements

Following your TOE you will be monitored in the CCU till the effects of the sedation/anaesthetic have worn off. Your throat may feel a little tender following the procedure. Before discharge the nursing staff will check that your eating and drinking has returned to normal, and you will then be discharged home.

Due to lingering effects of the sedation, you will not be able to drive for the following 24 hours (or operate heavy or dangerous machinery) so it is advisable that you arrange to be collected from the hospital.

What happens next?

At discharge you will be advised as to what follow-up arrangements will be necessary and how to make them.

The specialist imaging cardiologist will review the images obtained at the procedure and provide the full report to your cardiologist, and sometimes some direct discussion as well.