Heart Education Awareness Resource and Training through eLearning (HEARTe)

Transoesophageal echocardiogram

A Transoesophageal Echocardiogram (TOE) is an invasive procedure, where a transducer similar to an endoscope is passed through the mouth, down the throat, into the oesophagus and stomach to allow very clear and unobstructed imaging of the heart structures. It is done mainly to look closely at the valve structure and function, and assess the inter-atrial septum. The patient can have this procedure as an in-patient or electively as an out patient, however, the process is the same. The results are usually instant and often the patient is told at the time of procedure.

The procedure is normally quite straightforward, taking about 20 minutes. There are some risks involved, such as tearing of the oesophagus, damage to teeth/ mouth or breathing difficulties. The patient would be prepared and consented as for an invasive procedure. Cardiac monitoring and vital signs are continuously recorded during the procedure. The patient may be offered sedation as the procedure may be uncomfortable.

The patient will usually have had a standard transthoracic echo previously and the TOE is carried out to help assess and diagnose any problems that the transthoracic echo alone did not answer.

Indications Contraindications
  • Thorough native and prosthetic valve assessment prior to or during cardiac surgery.
  • Detection of intracardiac thrombus in left atrial appendage prior to cardioversion for atrial flutter/ fibrillation.
  • Detection and visualisation of intra-cardiac shunts.
  • Cardiac source of embolus.
  • Assessment of thoracic aorta/root
  • Good visualisation of aortic root where abcess may be suspected.
  • Assessment of intra-cardiac masses.
  • Oesophageal varices
  • Oesophageal obstruction or stricture
  • Recent gastric or oesophageal bleeding
  • Severe respiratory depression
  • Severe coagulopathy
  • Cervical spine injury or anomaly

How is it done?

The patient will be asked to fast for 6-12 hours before the procedure. Some centres will ask the patient to stop taking anti-coagulants such as Warfarin before the TOE.

See Additional Information, below, for a patient video on how the test is performed.

Page last reviewed: 30 Jul 2020