Transoesophageal Echocardiogram (TOE)

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Your doctor has advised you have a Transoesophageal Echocardiogram (TOE) to take detailed images (pictures) of your heart.  This leaflet will help you understand what will happen before, during and after the procedure.

How does my heart work?

Your heart is a muscle that pumps blood around your body. Sometimes people are born with or develop problems with the heart’s muscle, the chambers (ventricles and atria) or the structures within the heart such as the valves.

What is a TOE?

This test allows us to scan the heart’s structure and function using ultrasound (a painless examination using sound waves) to take detailed pictures.  Ultrasound is safe and no radiation (x-rays) is used.¹

It is like a standard echocardiogram (echo) but a TOE involves placing a small thin flexible tube into your oesophagus (gullet and stomach).  This gives your doctor clearer and more accurate pictures than a standard echo, as the oesophagus lies just behind the heart and there is no interference (unwanted signals) from the ribs or lungs.

You will be offered a local anaesthetic spray to the back of your throat and light sedation at the start of the procedure.  The sedation will make you feel relaxed but not asleep.

What are the risks and possible complications?

TOE is a safe procedure but does have some risks and possible complications. These will be discussed fully before you consent to the procedure. The risks must be compared to the benefits and your doctor will have considered these.

The risks and possible complications include:

• Aspiration:  If you are sedated and your stomach contains food and drink it can leak into your lungs, affect your breathing and cause an infection. This is one of the reasons why you must not eat or drink for 6 hours before the procedure.
• Perforation (hole) or a tear of the wall of the oesophagus: This can happen to 1 – 3 patients in every 10,000_.²  This is unlikely unless you have had a previous history of problems with your oesophagus.
• Bleeding:  If any bleeding occurs steps will be taken to stop it.
• Sore throat: You may have a sore throat for 24 – 48 hours.
• Damage to teeth or bridge-work:  The probe can occasionally cause damage to teeth or bridge-work. This is rare as a mouth-guard is used to minimise (reduce) the risk.
• Conscious light sedation: This can sometimes cause problems with breathing, heart rate and blood pressure.  You may feel some discomfort.
• Discomfort: You may feel some discomfort during the procedure, we try to keep this to a minimum.  A nurse will be with you throughout the procedure and if you show signs of being uncomfortable, steps will be taken to relieve this.

You must tell your doctor if you have had treatment such as surgery to your oesophagus, or if you know you have a narrowing of your oesophagus as these could increase the risks during the procedure.

What will I need to do to prepare for my procedure?

You should not eat or drink for 6 hours before your appointment.

It is important to arrange for someone to take you home and, if you have had sedation, stay with you for 24 hours after the procedure.  You must not drive, operate machinery, be in charge of young children or drink alcohol for 24 hours after the procedure. 

Depending on the type of job you do you may need to arrange time off work.  Your doctor or nurse can discuss this with you. 

You can expect to be at the Unit for about 3 hours.  There is limited space so only in special cases will anyone be allowed to stay with you, for example, patients with special needs. 

Unless advised you should use your inhalers and take your tablets or medicines as usual.  You may take these with a small amount of water.  There is no need to stop taking Warfarin, Clopidogrel or Aspirin before the procedure.  Please bring a list of all your medication (drugs) with you to your appointment.

You will be given a hospital gown to wear during the procedure and may wish to bring a dressing gown and something to read while you wait.

Please bring your reading glasses as you will need to read and sign a consent form.

Please do not bring any valuables, jewellery or large amounts of money as we are unable to accept responsibility for any loss or damage.

Where will I go to have my TOE?

Your procedure will usually be performed at the Cardiology Day Unit at the University Hospital of North Tees. You will be sent a letter telling you when and where to come.

It is important you arrive at your appointment time so we can prepare you for your procedure and answer any further questions you may have.

Who will be present during my procedure?

A team of healthcare professionals, including a cardiologist (a doctor who specialises in the heart), nurses and an echocardiographer (someone who is trained to carry out echoes).

North Tees and Hartlepool NHS Foundation Trust is a teaching organisation.  We could not train future doctors, nurses or other health professionals without the co-operation of patients.  You will be informed if there are to be any observers present.  Healthcare professionals in training may take part in your procedure according to their experience and stage of training.  They will be supervised by fully qualified staff at all times.

What will happen during the procedure?

The procedure takes about 20 – 30 minutes. You will be taken to the procedure room on your bed.  You will be connected to equipment to monitor (check) your heart rate and rhythm, blood pressure and blood oxygen levels.

Your throat will be sprayed with local anaesthetic to numb the area. A plastic mouth guard placed between your teeth.  You will be asked to lie on your left side. Sedation may be given, if needed. A nurse will stay with you to make sure you are comfortable.

You will be asked to swallow as the probe is inserted and passed into your oesophagus.

Your doctor and echocardiographer will record a series of moving pictures of your heart.

When the procedure is finished the probe is removed.

What happens after the procedure?

After the procedure you will be taken back to the Unit to rest and a nurse will continue to monitor your blood pressure, pulse and temperature regularly.  The cannula will be removed from your hand or arm.

Before you go home your doctor will see you again when he or she has the results and discuss with you the findings and treatment choices to help reduce your symptoms and improve your quality of life.  They will answer any questions you may have.

If you have had sedation you may feel sleepy and will need to stay for 1 – 2 hours after the procedure.

If you have not had sedation you may be able get dressed and go home after about 30 minutes – 1 hour.

You should not eat or drink for 30 minutes and have nothing hot for 1½ hours until the spray to numb your throat has worn off. 

Before you go home you will be given a leaflet ‘Transoesophageal Echocardiogram (TOE) Discharge advice’.

Will I need a follow-up appointment?

The results of the test will be sent to your doctor. You may be sent an appointment through the post to come for a follow-up appointment with a cardiologist.

Your GP will also receive a copy of the results.

Contact

If you need further advice, or have any problems, please contact:

Cardiology Day Unit – University Hospital of North Tees
Monday – Friday, 8.30am – 5.00pm

Non-urgent messages can be left at any time on the answering machine.

(This is a Hartlepool number but you will be diverted to North Tees).
Telephone: 01429 522020

Further Information

NHS Choices
Calls to this number are free from landlines and mobile phones
When it is less urgent than 999 call 111
Website: www.nhs.uk

British Heart Foundation
Greater London House
180 Hampstead Road
London
NW1 7AW
Monday – Friday, 9.00am – 5.00pm
Telephone: 020 7554 0000
Heart Help: 0300 330 3311
Website: www.bhf.org.uk

References

1. Ter Haar, G (2001) in Meire H, Cosgrove D, Dewbury K and Farrant P (editors); “Safety of Diagnostic Ultrasound” in Clinical Ultrasound: A Comprehensive text. Churchill Livingstone, pages 37-45.
2. American Society of Echocardiography (November 2010).

Comments, concerns, compliments or complaints

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We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

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Email: [email protected]

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Telephone: 01642 383551

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Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]

Leaflet Reference: PIL1097
Date for Review: 10/03/2024