Transesophageal Echocardiography (TEE) in Cardiology

Introduction

Transesophageal echocardiography (TEE) is a specialized ultrasound imaging technique used to obtain detailed images of the heart and its structures. Unlike transthoracic echocardiography (TTE), which uses an ultrasound probe on the chest, TEE involves inserting a probe into the esophagus to get closer to the heart. This results in clearer images, especially for evaluating heart valves, chambers, and detecting blood clots.

When Is TEE Used?

TEE is particularly useful in the following conditions:

1. Valvular Heart Disease

• Assessing valve function and detecting regurgitation or stenosis.
• Evaluating prosthetic heart valves.

2. Endocarditis

• Detecting infective endocarditis and associated complications such as abscess formation.

3. Atrial Fibrillation and Stroke Risk Assessment

• Identifying left atrial thrombus (blood clot), especially in the left atrial appendage.

4. Congenital Heart Defects

• Evaluating septal defects or anomalies that may not be visible on TTE.

5. Aortic Pathologies

• Detecting aortic dissections and aneurysms.

Benefits of TEE

• Higher resolution images: Provides superior image quality compared to TTE.
• Better assessment of posterior heart structures: Useful when transthoracic views are suboptimal.
• Guidance during procedures: Used in transcatheter valve replacements, atrial septal defect closures, and electrophysiological procedures.

Risks and Considerations

Though generally safe, TEE has some risks, including: - Discomfort or throat irritation. - Aspiration risk if fasting guidelines are not followed. - Esophageal injury or perforation (very rare). - Sedation-related complications.

Conclusion

TEE is a powerful diagnostic tool in cardiology, providing superior visualization of heart structures compared to TTE. It is invaluable in detecting critical conditions such as valve disease, endocarditis, and thrombus formation. While it has minimal risks, it is usually well-tolerated and often essential for accurate cardiac diagnosis.

References to Clinical Guidelines

Below are major guidelines that provide recommendations on TEE use:

Source recommendations

1. American Society of Echocardiography Guidelines on Transesophageal Echocardiography

1. https://www.asecho.org/guidelines-search/
2. https://www.onlinejase.com/article/S0894-7317(18)30475-9/fulltext
3. https://www.asecho.org/wp-content/uploads/2014/05/2013_Performing-Comprehensive-TEE.pdf
4. https://pubmed.ncbi.nlm.nih.gov/23998692/
5. https://asecho.org/wp-content/uploads/2015/01/ChamberQuantification2015.pdf

2. European Association of Cardiovascular Imaging Recommendations on Echocardiography

1. https://academic.oup.com/ehjcimaging/article/14/7/611/2465068
2. https://pubmed.ncbi.nlm.nih.gov/23733442/
3. https://www.sciencedirect.com/science/article/pii/S0894731714007457
4. https://pubmed.ncbi.nlm.nih.gov/23239795/
5. https://academic.oup.com/ehjcimaging/article/16/2/119/2403341