Originator: Anne DrewnickiDate: April 2012

Version: 2Date for Review: April 2015

DGOH Ref No: DGOH/PIL/00414

TransoesophagealEchocardiogramCardiac Physiology DepartmentPatient Information Leaflet

2 7

Contact numbers

If you have any questions or are unsure about any of theinformation provided in this leaflet, please contact the CardiacPhysiology Department, Russells Hall Hospital on Tel 01384244582 or via switchboard on Tel 01384 456111.

If you have any questions or are unsure about any of theinformation provided in this leaflet, please contact the CardiacPhysiology Department, Russells Hall Hospital on Tel 01384244582 or via switchboard on Tel 01384 456111.

A written report of your test results will be sent to your referringdoctor. You may experience some soreness in the throatafterwards. This should resolve in a day or two.

Are there any risks?

The procedure is very safe and complications are rare.Occasionally bruising of the back of the throat can occur.

Further Information

If you are concerned about your condition, please call thedepartment for advice:

Cardiac Physiology Department, Russells Hall Hospital 01384244582.

6 3

What is a TransoesophagealEchocardiogram (TOE) and why do I needone?

A TOE is an ultrasound scan of the heart performed by passing aprobe on the end of a flexible scope into your oesophagus (the'food pipe'). The scope is similar to the 'camera' used to look for astomach ulcer. The oesophagus lies directly behind the heart, withno intervening structures, so the images are much clearer thanthose from the front of the chest (transthoracic echocardiography),where the chest wall, ribs and lungs get in the way. TOE isparticularly useful to look at the mitral valve and to find holes in theheart, blood clots or evidence of infection.

What should I do before the test?Do not eat for 4 - 6 hours or take fluids for up to 4 hoursbefore your test (exact times may vary between hospitals).This includes water except for taking tablets.Unless instructed otherwise by your doctor, you shouldcontinue to take normal medications (including Warfarin).Have them with just a sip of water.Many patients prefer to have a sedative for the test, and soyou should arrange for a responsible adult to accompany youto your appointment and escort you home as you may feelsleepy following your sedation. If sedation is used routinely atyour hospital, your test may not be carried out unless aresponsible adult accompanies you.

The sedative can have a 'hangover' effect. Although you may feelfine, your reasoning, reflexes, judgement, co-ordination and skillcan all be affected by having sedation.

Until the next day after your test, please donot:-

Drive any vehicle, including riding a bicycleOperate any machineryAttempt to cook, use sharp utensils or pour boiling fluidsDrink alcohol or smokeTake sleeping tabletsMake any important decisions or sign any legal contracts

After the examination as an inpatient:

1. If you had a sedative injection, you may feel sleepy for several hours after the medications given.2. Do not eat for at least 1-2 hours after the test, your gag reflex will return and there in no risk of choking when you eat and drink again.3. The nurse will check your blood pressure, respirations and pulse until you are completely awake.4. Occasionally some patients experience a sore throat. This will subside in the next day or so without medication.

MEDICATIONS GIVEN: MIDAZOLAM, FLUMAZENIL, FENTANYL.

If you have difficulty in swallowing or have ever had surgeryon your throat or gullet, you should inform the department assoon as you receive your appointment. It may be necessary tohave further investigations prior to this test.

What will happen when I arrive?

On arrival you will usually be met by a doctor or CardiacPhysiologist who will explain the test, ask some questionsaccording to a routine checklist and ask you to sign a consent form.

What does the test involve?

The test is performed on a couch or bed. A small cannula may beinserted into an arm vein (like a blood test) to administer sedation,or to perform a contrast study. An ECG and a blood oxygenmonitor will be attached and you may be given oxygen throughyour nose. You will be asked to remove any dentures and yourthroat will be sprayed with local anaesthetic to make it numb. A biteguard will be placed between your front teeth. The tube islubricated then placed at the back of the mouth.

You will be asked to swallow a small number of times to help itpass into the 'food pipe'. This may be uncomfortable, but will not bepainful. Once the probe is in place, it is only mildly uncomfortable.You can breathe through your mouth or nose.

If a contrast study is required, a small injection will be made duringthe test, which enhances the quality of the pictures. The actualinjection is painless. The liquid used is usually just salt water mixedwith a little blood, but if you have any special allergies, particularlyto eggs, you should tell the doctor beforehand.

How long will it take?

The procedure, including preparation, may take up to 1 hour andyou should usually allow up to 2 hours including waking upafterwards if sedation is used. The probe is usually in the 'foodpipe' for a much shorter time, typically 10 minutes.

What happens after the procedure as anoutpatient?

If you have not had sedation you can go home straight away butshould not eat or drink for up to one hour. Check that the localanaesthetic has worn off using cold water before taking anythinghot.

If you have had sedation, you will be asked to sit or lie in arecovery area in the department for 1 - 2 hours to recover until youfeel awake enough to travel home. You must rest for the rest of theday and arrange for someone to take you home and be with you for24 hours.

4 5