When transesophageal ultrasound is needed
In situations where transthoracic echocardiography does not allow adequate visualization of the structures of the heart, transesophageal echocardiography is recommended for a correct diagnosis.

How the procedure works
Transesophageal ultrasound involves inserting a flexible tube with an ultrasound probe into the esophagus and stomach to visualize the surrounding heart, unobstructed by other structures. The procedure is similar to gastroscopy and is performed after fasting for at least 6 hours. Feeding can be resumed about two hours after the examination, after the patient has regained cold sensation.

The examination is not painful, but may cause mild discomfort, such as a feeling of vomiting when the probe touches the pharynx. This sensation disappears after swallowing the tube and may reappear during the course of the investigation as the investigation progresses or is withdrawn. Breathing is not affected as it is done through the nose.

The procedure can be carried out:

• with local anesthesia (neck spray),
• or with sedation (for increased comfort), in which case the presence of the ICU team and monitoring of the patient until full recovery of consciousness is required.

Before the investigation begins, it is placed:

• electrodes for EKG monitoring,
• a blood pressure cuff,
• pulse oximeter for oxygen saturation,
• an intravenous cannula to administer any necessary or emergency medication.

Indications for transesophageal ultrasound
The procedure is recommended in the following situations:

• when transthoracic ultrasound does not provide enough detail,
• for further information on valves (plastics, repairs),
• after stroke or peripheral stroke, to identify the cause (clots, infectious vegetations, tumors, cholesterol or calcium plaques),
• evaluation of valve prostheses,
• examination of congenital lesions,
• exclusion of clots before cardioversion of atrial fibrillation,
• examination of the thoracic aorta,
• in valve repair surgery and ventricular reconstruction,
• during interventional procedures: valve implants (aortic, mitral - MitraClip), closure of septal defects, closure of the left auricle, electrophysiology procedures,
• monitor cardiac function during surgery and guide drug treatment.

Contraindications
The procedure is not recommended in cases of:

• severe diseases of the upper digestive tract (ulcers, diverticuli, esophageal varices),
• obstructions or trauma to the esophagus,
• gastric ulcer,
• cervical spine injuries.

Risks and complications
Complications are rare and can include:

• lesions of the upper digestive tract,
• heart rhythm disturbances,
• shortness of breath.