Transesophageal Echocardiography for Children

What is transesophageal echocardiography (TEE) for children?

Echocardiography is an imaging test. It uses sound waves to make detailed moving pictures of the heart. It shows the size and shape of the heart, as well as the heart chambers and valves. It also shows how the different parts of the heart move when the heart beats as blood passes through the different chambers. Transesophageal echocardiography (TEE) uses a device that is placed in the esophagus. The esophagus is the tube leading from the throat to the stomach. It's located behind the heart in the chest. TEE may be used when certain pictures of the heart are needed.

The other type of echocardiography is called transthoracic echocardiography (TTE). This test uses a device that is moved across the outside of the chest. TEE can give more detailed images than TTE. It may be a better test, depending on what is being assessed.

Most echocardiography is 2-D. Two views of the heart are used to create the images. Other types include:

Doppler. This shows how much blood flows through the heart and in which direction.
Color Doppler. This shows color images to better see blood flow.
3-D. This gives 3-D views of the heart.
Stress echocardiography. This shows how the heart beats and moves blood while under stress from medicine or exercise.

Why might my child need transesophageal echocardiography?

Echocardiography is one of the most important imaging tests for heart problems in infants and children. It may help diagnose problems your child was born with (congenital). It can also help diagnose problems that have developed (acquired). Below are reasons for having echocardiography. A TEE may be indicated rather than a TTE when more detailed images of the heart are required that can't be obtained using a TTE.

Congenital (present at birth)

Symptoms that may mean a heart problem. This might be a bluish color of the skin (cyanosis) or a heart murmur.
Other congenital problems
Family history of congenital heart disease
Other abnormal test results

Acquired

Infections or other conditions that may affect the heart
High blood pressure
Irregular heartbeats (arrhythmias)
Changes to the different parts of the heart, such as chambers or valves

TEE may also be used during procedures such as heart catheterization or heart surgery.

What are the risks of transesophageal echocardiography for a child?

In general, echocardiography does not have any risks. There is a small risk for problems from the medicine used to help your child relax (sedative) or anesthesia. There is also a small risk for damage to the mouth, esophagus, and throat in rare cases. Talk with your child's cardiologist about this risk.

How do I get my child ready for transesophageal echocardiography?

Talk with the cardiologist or someone at the facility about how to get your child ready for the test.

Follow any directions your child is given for not eating or drinking before the test. They may also need to take or stop certain medicines if they increase the risk for complications. If your child is old enough, explain what will happen. You might ask the cardiologist or nurse to help explain the procedure.

What happens during transesophageal echocardiography for a child?

TEE may be done at a hospital or at an imaging facility. It takes about an hour to do the test. The steps are as follows:

Your child will be given medicine (sedation) through an IV (intravenous) line. Depending on your child's age, general anesthesia may be used. They will be asleep during TEE.
The healthcare staff will monitor your child's heart rate, rhythm, blood pressure, and oxygen levels at all times.
A mouth guard or bite protector will be placed in your child's mouth.
The healthcare provider will put a device called a transducer in your child's mouth, down their throat, and into the esophagus.
The transducer sends and receives sound waves that bounce off the heart. The sound waves create images of the heart that are displayed on a computer screen.

What happens after transesophageal echocardiography for a child?

Your child will be watched after the TEE until the sedative wears off. Their blood pressure, heart rate, and oxygen will be checked. Since the probe is passed through the throat, your child might have a sore throat.

A pediatric cardiologist will look at the results of the TEE. Depending on the results, your child may need other tests or procedures.

Next steps

Before you agree to the test or the procedure for your child, make sure you know:

The name of the test or procedure
The reason your child is having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
When and where your child is to have the test or procedure
Who will do the procedure and what that person’s qualifications are
What would happen if your child did not have the test or procedure
Any alternative tests or procedures to think about
When and how you will get the results
Who to call after the test or procedure if you have questions or your child has problems
How much you will have to pay for the test or procedure