From the Guidelines
Transesophageal echocardiography (TEE) is indicated for the evaluation of suspected infective endocarditis, prosthetic heart valve function, and other specific cardiac conditions that require enhanced visualization, as it provides superior imaging quality compared to transthoracic echocardiography (TTE) 1. The primary indications for TEE include:
- Evaluation of suspected endocarditis to detect vegetations on heart valves
- Assessment of prosthetic heart valve function
- Diagnosis of aortic dissection or aneurysm
- Detection of cardiac sources of embolism in patients with stroke or peripheral embolization
- Evaluation of complex congenital heart disease TEE is also used during cardiac surgeries and interventional procedures for real-time guidance, assessment of atrial appendage for thrombus before cardioversion in atrial fibrillation, and evaluation of cardiac masses or tumors 2. The procedure involves inserting an ultrasound probe into the esophagus, which provides superior imaging quality due to the esophagus's proximity to the heart without interference from chest wall structures or lung tissue, allowing for higher frequency ultrasound use and better resolution of cardiac structures, particularly the left atrium, atrial septum, mitral valve, and aorta 3. TEE requires conscious sedation or general anesthesia and carries small risks, including esophageal trauma, bleeding, and aspiration, making it appropriate only when the diagnostic benefits outweigh these risks 4. In patients with suspected infective endocarditis, TEE has been shown to have a high sensitivity and specificity for detecting vegetations, paravalvular abscesses, and other complications, making it a valuable tool for diagnosis and management 1. The American College of Cardiology and American Heart Association guidelines recommend TEE as a first-line diagnostic test for patients with suspected infective endocarditis, particularly those with prosthetic valves or other high-risk conditions 5.
From the Research
Indications for Transesophageal Echocardiogram (TEE)
The primary indications for TEE include:
- Assessment of cardiac source of embolism 6, 7
- Suspected endocarditis 6, 8
- Suspected prosthetic valve dysfunction 6
- Assessment of thoracic aorta and other vessels 6, 7
- Assessment prior to valvular repairs and closures of septal defects 6
- Intraoperative monitoring of cardiac or percutaneous interventions 6, 9
- Ablation 6
- Non-diagnostic transthoracic examination, especially in patients after cardiac surgeries 6
- Evaluation of left atrial thrombus and associated pathology 10
- Cryptogenic stroke 7, 10
Clinical Scenarios where TEE is Superior to TTE
TEE provides excellent visualization of cardiac structures and is superior to TTE in certain clinical scenarios, including:
- Hemodynamically unstable patients with suboptimal TTE images or if mechanically ventilated 9
- Patients with suspected aortic dissection or aortic injury 9
- Suspected endocarditis 9, 8
- Cardiac or aortic source of emboli 9, 7
Diagnostic and Therapeutic Impact of TEE
TEE has a significant diagnostic, therapeutic, and surgical impact on patient management in critically ill patients, ranging from 44% to 99% 9. The use of TEE in critically ill patients has been shown to have a low complication rate of 2.6% 9.