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Regional Cardiac Centre
Morriston Hospital, Swansea
Patient Information Leaflet
Transoesophageal Echocardiogram (TOE)
What is a TOE?
This is a test that allows us to take detailed images of your heart using high pitched sound waves which you can’t hear. The technology is similar to that for a standard ultrasound examination (involving placing a probe and jelly on the skin), but a TOE involves placing the probe into the gullet or oesophagus and stomach. This probe is a narrow tube, much smaller than the one used on the skin and similar to a “magic eye” used to examine the stomach. This gives very clear and accurate moving pictures of the heart, much better than can be produced using a probe on the skin. Each person’s individual condition is unique. This leaflet contains general information and is not a substitute for discussion with the doctor or nurse.
Why have the test?
This test will give us additional information on the state of your heart muscle and valves that should allow us to decide on whether you need treatment and which treatment options are available to you e.g. it might tell us why a valve is leaking and whether it can be repaired or needs replacing. This test is not a treatment, it gives us more information regarding you diagnosis and helps us in deciding which treatment options are best for you.
What does the procedure involve?
The procedure usually involves coming to the hospital for a few hours. It is performed by a specialist doctor and a cardiac physiologist and takes about 15-30 minutes. The doctor will talk to you about the procedure beforehand, ensure that you understand why you are having the procedure, what it involves, including the benefits and risks to you. Please do not hesitate to ask any questions. The doctor will then ask you to sign a consent form.
You will be asked to lie on a bed and will be attached to a heart monitor and oxygen supply. Your heart rate and oxygen level will be monitored via a simple clip attached to your fingertip or earlobe. A small drip needle or cannula will be placed in your arm through which we can give medication if necessary. You will we asked to remove any spectacles, contact lenses, dentures or plates. Your mouth and throat will be numbed with a local anaesthetic spray and a plastic mouthpiece placed in you mouth. The mouthpiece is to prevent damage to your teeth (and to protect the probe from your teeth!). You will be asked to lie on your left side, and the tube will then be passed gently through your mouth into the gullet and stomach. You will be asked to swallow initially to help the tube along. The initial procedure is slightly uncomfortable, but not painful. Once the probe is passed into the gullet, it is much more comfortable. The tube is small and will not interfere with your breathing. The doctor will adjust the probe position in the gullet and record pictures. You may watch the pictures as they are taken if you wish. We may need to inject some fluid (usually salty water) through the drip needle for some examinations. Some patients produce excessive saliva during the test and we can easily remove this for you using a suction device, as in the dentist.
This test is commonly performed without any sedation, but if you wish we can give you a drug to make you drowsy. If you have the sedation, you will need to stay in hospital for at least an hour, sometimes more, and may not feel yourself for the rest of the day. If you receive sedation, you must not drive, operate machinery, drink alcohol or sign any documents for at least 24 hours, and a responsible adult must accompany you home and stay with you overnight.
What are the risks involved?
The procedure is very safe and the benefits of the test generally outweigh the risks. Most patients will feel minor mouth and throat discomfort after the test. There is a small risk of damage to teeth, particularly if they are loose or capped. This is minimized by using a plastic mouthpiece. Some patients may experience some breathing difficulty after the anaesthetic mouth spray, but this is rarely serious. Minor bleeding from the mouth is not uncommon but again rarely serious. There is a very small risk of causing damage to the gullet – this is extremely rare but may require major surgery if it occurs. Most patients have mild bruising at the site of the drip needle. You must tell us if you are known to have any allergies - it is rare for patients to have an allergic reaction to the drugs used.
The risk of major complication is very low indeed. The risk is however dependant on your general state of health and well-being and any other illnesses that you may have and may be higher in some instances. The doctor will be happy to discuss this further should you wish.
Please ensure that you tell us before the test if you have ever had surgery to the mouth, neck, gullet or stomach, have difficulty swallowing, have liver disease, a blood clotting disorder or have coughed up or vomited any blood.
What preparation do you need?
Please continue your normal medication. There is usually no need to discontinue Warfarin or Aspirin or any other medication prior to the test.
On the morning of the test please do not eat for 6 hours before the procedure. You may drink small amounts and take any medication, up to 4 hours before the test.
If you are diabetic, do not take your insulin or tablets on the morning of the test, but bring them with you so that you can take them as soon as you are able to eat after the test.
Please ensure that a responsible adult, ideally a friend or relative accompanies you to the examination, as you may need to be taken home if you have a sedative. A responsible person may also need to stay with you overnight. If you need NHS transport, please ask your GP’s surgery to book this, with a return journey booked 2-3 hours after the time of the test. If you experience problems, please ring the consultant’s secretary for advice.
Please inform us beforehand if you may be pregnant or are breast-feeding. Do not bring any excess money or valuables with you on the day. Please wear loose casual clothing.
After the examination
If you did not have sedation, you may go home almost immediately following the procedure. Because of the local anaesthetic spray, you will not be able to eat or drink safely for at least an hour after the test. You must wait until your throat and mouth are no longer numb and then take a small amount of clear water first. If this is swallowed easily without coughing and you feel a normal sensation on swallowing, you may then eat and drink normally. Do not eat or drink anything hot for at least 2 hours. Your throat may feel mildly sore for a day or two after the test.
If you had sedation, we will move you to another recovery room and a member of staff will watch you until you have woken up fully. Please remember that you must not drive, operate machinery (including a kettle or oven), drink alcohol or sign any documents for at least 24 hours. A friend, relative or carer must accompany you home and stay with you overnight. Do not be alarmed if you do not remember the procedure as the sedating medication can also affect your memory of the procedure.
The drip needle site in your arm is unlikely to cause any problems, but if you notice any excessive swelling, redness, soreness or heat at the site, please seek help from a doctor or nurse as this may indicate an infection which may require antibiotics.
The doctor may wish to talk to you about the findings of the examination after the test. Alternatively, if referred by another consultant, the doctor doing the test will inform that consultant of the results so that they can arrange to see you again to discuss the findings.
If you have any questions, please contact either the consultant’s secretary or cardiac outpatients on 01792 704101 (09:00-17:00)