Heart valve disease
Assesses valve anatomy and function, including stenosis, regurgitation, torn tissue, prolapse and the severity or mechanism of valve disease.
Advanced Cardiac Imaging
Transesophageal Echocardiography (TEE)
A specialised ultrasound test that places a slim probe in the food pipe to obtain highly detailed images of the heart, valves, upper chambers and nearby major blood vessels.
Detailed heart images
No surgical incision
Usually a day-care test
♥Detailed imaging of heart valves and internal structures
Test typeInternal heart ultrasound
PreparationFasting is required
ComfortThroat numbing + sedation
RecoveryObservation before discharge
Understanding the test
What is transesophageal echocardiography?
Transesophageal echocardiography, commonly called TEE, is an ultrasound examination that creates detailed moving images of the heart. Instead of placing the ultrasound probe on the chest, the doctor gently guides a thin, flexible probe through the mouth into the esophagus, also known as the food pipe.
The esophagus lies directly behind the heart. This close position allows the probe to capture clearer views of structures that may be difficult to see with a routine transthoracic 2D Echo, particularly the heart valves, left atrium, left atrial appendage, atrial septum, prosthetic valves and portions of the aorta.
01
Closer imaging position
The probe sits behind the heart, reducing interference from the ribs and lungs.
02
Detailed valve assessment
Provides refined views of valve anatomy, leakage, narrowing and artificial valves.
03
Procedure planning
May support diagnosis, treatment planning and guidance during structural-heart procedures.
TEE is not the same as a routine 2D Echo. A standard Echo is performed from the chest and generally needs no sedation. TEE uses a probe in the esophagus and therefore requires fasting, monitoring and specific recovery instructions.
Detailed cardiac evaluation
What can a TEE evaluate?
The exact examination is tailored to the patient’s symptoms, previous test results and the clinical question that needs to be answered.
Blood clots
Helps look for clots in the left atrium or left atrial appendage, particularly in patients with atrial fibrillation or before selected procedures.
Endocarditis
Can identify suspicious growths, valve damage, abscesses or complications when infection of a heart valve or its lining is suspected.
Congenital defects
Provides detailed assessment of openings or abnormal connections, such as atrial septal defects and patent foramen ovale, when clinically relevant.
Aorta and major structures
Helps evaluate portions of the thoracic aorta for enlargement, plaque, tears or other abnormalities when TEE is clinically appropriate.
Prosthetic valves and devices
Examines artificial valves, closure devices and possible leaks, obstruction, infection or abnormal movement around implanted cardiac structures.
Clinical indications
When may a doctor recommend TEE?
TEE is usually advised when a routine chest Echo does not provide enough detail or when precise imaging is needed to guide an important treatment decision.
01Unclear or incomplete findings on a routine 2D Echo
02Suspected clot before cardioversion for atrial fibrillation
03Detailed assessment of mitral, aortic or prosthetic valves
04Possible infective endocarditis or valve-related infection
05Evaluation of an unexplained stroke or systemic embolism
06Assessment of ASD, PFO or another structural heart defect
07Planning for valve repair, closure devices or structural intervention
08Monitoring during selected cardiac surgery or catheter procedures
TEE is not automatically required for every heart problem. The cardiologist chooses it when the additional detail is likely to change diagnosis, procedure planning or treatment.
Structural-heart imaging
How TEE supports advanced heart procedures
TEE may be used before or during selected interventions to define anatomy, confirm device suitability and help the treatment team monitor the result in real time.
Before the procedure
Detailed views help assess the mechanism and severity of valve or structural disease and identify anatomical features important for treatment selection.
- Valve morphology and severity
- Septal defect size and rims
- Left atrial appendage anatomy
- Suitability for selected devices
During the procedure
Real-time 2D, colour Doppler and sometimes 3D imaging may guide catheter position, device deployment and immediate decision-making.
- MitraClip or other valve procedures
- ASD or PFO device closure
- Left atrial appendage closure
- Selected surgical procedures
After treatment
The team can assess device position, valve function, residual leakage, blood flow and possible complications before completing the procedure.
- Final device position
- Residual shunt or regurgitation
- Pericardial fluid
- Immediate treatment result
Before your appointment
How to prepare for a TEE
Preparation is important because the probe passes through the throat and sedation may be used. Follow the exact instructions provided by the hospital or cardiology team.
Before arriving
- Do not eat or drink for the period advised by your medical team.
- Ask which regular medicines should be taken on the day of the test.
- Tell the doctor about diabetes medicines, insulin and blood thinners.
- Bring previous Echo, ECG, CT, MRI and hospital reports.
- Arrange for a responsible adult to take you home after sedation.
Tell the team in advance
- Difficulty swallowing, painful swallowing or frequent choking.
- Known esophageal disease, narrowing, varices, ulcers or previous surgery.
- Loose teeth, dentures, dental bridges or significant mouth problems.
- Medication allergies, breathing problems or previous sedation reactions.
- Pregnancy or any major change in your health before the test.
Do not guess the fasting duration. The required time can vary with the planned sedation, hospital protocol and your medical condition. Follow the instructions given specifically for your appointment.
Step-by-step
What happens during the TEE procedure?
The team explains the test, checks your medical history and monitors you throughout the procedure.
Consent and safety check
Your identity, fasting status, medicines, allergies, dental condition and relevant throat or esophageal history are reviewed.
Monitoring and intravenous line
ECG electrodes, a blood-pressure cuff and an oxygen monitor are applied. An IV line is placed for medicines and fluids.
Throat numbing and sedation
A local anaesthetic spray helps reduce the gag reflex. Sedative medicine may be given to help you remain relaxed and comfortable.
Placement of the probe
While you lie on your side, a mouth guard is positioned and the lubricated flexible probe is gently guided through the mouth into the esophagus.
Detailed image acquisition
The doctor adjusts the probe to record the required views using two-dimensional imaging, Doppler and, when needed, three-dimensional imaging.
Probe removal and recovery
The probe is removed after imaging. You remain under observation until you are awake, stable and safe for discharge or further treatment.
After the test
Recovery and care after TEE
Most patients are discharged after a period of observation, but recovery instructions depend on the medicines used and whether TEE was part of another procedure.
Wait before eating
Do not eat or drink until the throat numbness has fully worn off and the care team confirms that swallowing is safe.
Plan an escorted return
After sedation, a responsible adult should take you home. Do not drive, operate machinery or make important decisions until advised.
Expect mild throat discomfort
A mild sore throat or temporary swallowing discomfort may occur. It usually improves, but worsening symptoms should be reported.
Seek urgent medical advice for severe or increasing chest pain, breathing difficulty, vomiting blood, black stools, fever, persistent difficulty swallowing or any symptom that feels serious after discharge.
Safety information
Is transesophageal echocardiography safe?
TEE is commonly performed and is generally safe when patients are properly selected and monitored. Because it is semi-invasive and often uses sedation, it has more risk than a routine chest Echo.
More common temporary effects
- Gagging or discomfort while the probe is introduced.
- Mild sore throat or temporary swallowing difficulty.
- Drowsiness, nausea or dizziness related to sedation.
- Minor irritation of the mouth, throat or esophagus.
Uncommon or rare complications
- Reaction to sedative or numbing medication.
- Breathing difficulty, aspiration or changes in heart rhythm.
- Dental injury or bleeding from the throat or esophagus.
- Serious esophageal injury, including perforation, is rare.
Your doctor considers your swallowing history, esophageal conditions, bleeding risk, breathing status and the urgency of the cardiac question before recommending TEE.
Understanding the report
What may the TEE report include?
The report documents the structures examined, measurements, Doppler findings and the cardiologist’s clinical interpretation.
Heart chamber size and function
Valve anatomy and severity of disease
Presence or absence of intracardiac clot
Evidence of vegetation or endocarditis
ASD, PFO or other abnormal communication
Prosthetic valve or device assessment
Aortic findings within the visualised segments
Findings relevant to procedure planning
A TEE result should be interpreted together with symptoms, examination findings, ECG, blood tests, transthoracic Echo and other imaging. One finding should not be used for self-diagnosis.
Other cardiac tests
Will another investigation be needed?
TEE answers specific structural questions. Additional testing may be selected when the doctor needs information about coronary arteries, rhythm, heart muscle, blood flow or another anatomical area.
Transthoracic 2D Echocardiography
Electrocardiogram or Holter monitoring
CT Coronary Angiography
Cardiac CT for structural planning
Cardiac MRI
Coronary Angiography
Blood cultures for suspected infection
Procedure-specific imaging and assessment
Cardiologist-led care
Dr. Kiran Lakkireddy
MBBS, MD, DM (Cardiology – JIPMER), FSCAI, FAPSIC
Senior Interventional Cardiologist
Senior Interventional Cardiologist
Dr. Kiran Lakkireddy provides evidence-based cardiac evaluation with a focus on precise diagnosis, transparent communication and individualised treatment planning. His clinical practice includes complex coronary intervention, congenital cardiac intervention and advanced structural-heart therapies.
Apollo Hospitals, Jubilee Hills
CANES Cardio & Neuro Clinic, Kondapur
Patient questions
Frequently asked questions
Clear answers to common questions about transesophageal echocardiography.
Why is TEE clearer than a normal Echo?
The esophagus lies close to the heart. Placing the ultrasound transducer there reduces interference from the ribs, lungs and chest wall, allowing detailed views of selected heart structures.
Is TEE painful?
Throat numbing medicine and sedation are commonly used to improve comfort. You may notice pressure, gagging or throat discomfort, but the team monitors you and adjusts care as needed.
Will I be fully unconscious?
Many diagnostic TEE examinations use moderate sedation rather than full general anaesthesia. The planned sedation depends on the patient, hospital protocol and whether TEE is part of another procedure.
Why must I fast before TEE?
Fasting reduces the risk of stomach contents entering the lungs while the throat is numb or sedation is being used. Follow the exact fasting instructions given by your medical team.
How long does the test take?
The imaging portion often takes less than an hour, but preparation and recovery add time. Complex examinations or TEE performed during another cardiac procedure may take longer.
Can I drive home after TEE?
Not after receiving sedation. Arrange for a responsible adult to take you home and follow the discharge instructions regarding driving, work and important decisions.
When can I eat or drink afterward?
Wait until the throat numbness has completely worn off and the care team says it is safe. Eating too early can increase the risk of choking.
Can TEE find a blood clot before cardioversion?
TEE is commonly used to look for a clot in the left atrium or left atrial appendage when this information is needed before cardioversion. The result helps the treating cardiologist decide the safest next step.
Can TEE diagnose endocarditis?
TEE can show vegetations, valve damage, abscesses or other findings that support the diagnosis. Results must be combined with symptoms, examination, blood cultures and other clinical information.
Is a sore throat normal after the procedure?
Mild throat soreness for a short period can occur. Contact the medical team if discomfort becomes severe, persists, or is associated with breathing difficulty, bleeding, fever or increasing swallowing problems.
Who may not be suitable for TEE?
Certain esophageal disorders, active bleeding, severe swallowing problems or other medical conditions may change the safety assessment. Inform the doctor about any previous esophageal diagnosis, surgery or swallowing difficulty.
Will TEE be used during a structural-heart procedure?
It may be used for selected procedures to define anatomy, guide device placement and assess the immediate result. The imaging plan depends on the specific intervention and the heart team’s protocol.
Appointments in Hyderabad
Has your cardiologist advised a TEE?
Book a cardiac consultation to review the indication, preparation requirements, previous reports and the next step in your care.
This page provides general patient education and does not replace medical consultation. The indication, preparation, sedation plan, risks and interpretation of TEE depend on individual clinical assessment and hospital protocol.