Transoesophageal Echocardiogram (TOE)
- Interventional Cardiology
About this procedure
This guide provides information about a transoesophageal echocardiogram (TOE) procedure. It includes details about what is involved, how to prepare and what to expect during and after the procedure. Please use this in addition to information from your doctor and nurse.
A transoesophageal echocardiogram (TOE) is performed in a procedure room or an angiography suite at IntraCare in Epsom or North Harbour. Your cardiologist will be assisted by our team of nurses and other highly skilled personnel.
What is a ‘TOE’?
A transoesophageal echocardiogram (TOE) is a type of ultrasound scan undertaken to assess the structure and function of the heart. During the procedure, a flexible probe is passed through the mouth to the oesophagus, providing very high-quality images of the heart and the valves in 2D and 3D.
Common indications for a TOE
- To look for causes of a stroke such as blood clots, any defects like a flap (Patent Foramen Ovale) or a hole (Atrial Septal Defect) between the upper chambers of the heart, or plaque in the aorta.
- To show the exact mechanism and severity of regurgitation (leaking), prolapse (bulging), or stenosis (narrowing) of heart valve/s for possible treatment with surgery or replacement.
- To assess for any problems with the aorta.
- To ensure a blood clot is not in the heart before a cardioversion or electrical procedure for patients with atrial fibrillation or atrial flutter.
- To gather specific information before certain procedures such as a device closure of the left atrial appendage.
Before the procedure
Pre-procedure phone call
A nurse from IntraCare will call you 24–48 hours prior to your procedure to discuss the following information:
- Your admission time.
- When you should stop eating and drinking.
- Medication instructions.
- Allergies (including medications, contrast dye, dressings/plasters and food).
- Answer any further questions.
Anticoagulation (blood thinner)
- If you take Aspirin/Cartia and/or Clopidogrel you may continue to take these.
- If you take any other blood thinners (e.g. Warfarin, Dabigatran/Pradaxa, Rivaroxaban, Apixaban), your cardiologist will advise if you need to stop this medication temporarily for a few days before the procedure.
Warfarin
If you are currently taking Warfarin, please inform IntraCare via email or phone as soon as possible. Our nurses will review your INR levels and advise any medication changes if necessary.
Other regular medications
Please continue to take these unless advised otherwise by your cardiologist. If you are taking a diuretic or water pills (e.g. frusemide, spironolactone) you may need to withhold this on the morning of the procedure.
Reminders for the day of your procedure
- If you are on regular medication, please bring this with you in its original packaging.
- Please leave all your jewellery and valuables at home. You are welcome to bring your mobile phone in with you.
- We recommend wearing loose-fitting clothing and shoes that are easy to slip on/off.
- You are encouraged to bring a friend or a family member as a support person before and after your procedure.
- Please arrange for someone to drive you home after the procedure as you will not be able to drive for 24 hours following your TOE.
- The planned procedure time is an estimate only and may vary. We will keep you informed of any unexpected delays on the day.
Informed consent
As with any procedure, there are potential risks involved. Your cardiologist will explain the procedure, discuss possible risks and answer any questions you may have. Your whānau or support person are welcome to be part of this discussion. You will then be asked to sign the consent form. This will occur either at an earlier appointment, or on the day of your procedure.
Your procedure
The procedure usually takes 20–30 minutes and should not be painful or uncomfortable.
Preparation
A small intravenous (IV) line will be inserted into a vein in your arm. This will be used to administer medication to help you relax and to keep you comfortable during the procedure.
Once you are in the procedure room or suite, devices for monitoring blood pressure, heart rate and oxygen levels will be fitted to ensure your safety during the procedure. You will also be given oxygen through small prongs in your nose.
Your cardiologist will spray your throat with local anaesthetic (lignocaine) to help numb the area. A bite block is then placed into your mouth to prevent you biting the TOE probe. You will then be positioned on your left side and the flexible ultrasound probe will be passed to your oesophagus, providing very high-quality images of the structure and function of heart. Most patients fall asleep and have minimal recollection of the actual procedure.
After your procedure
You will be taken to recovery where the nursing team will monitor your recovery. If appropriate, you will be discharged home after 1.5–2 hours.
Going home and recovery
- Following your procedure, it is important that you do not drive for 24 hours. Please ensure you have a family member or friend to drive you home from the hospital, as you may still be under the effects of sedation.
- Please arrange for someone to stay the night with you at home after your procedure to support your recovery.
- Due to the short sedation, you may feel lethargic afterwards with reduced concentration. For this reason, for 24 hours after your procedure it is important you:
- Do not make any legal decisions or sign legal documents.
- Do not do any activity requiring strength, concentration, or full alertness for the rest of the day.
- We advise you not to return to work for the day of your procedure.
- You may resume normal activity the following day.
- Over the next day it is normal for your throat to feel a little uncomfortable. You can use lozenges if required.
- If you have any concerns, please contact IntraCare:
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- Monday to Friday (6:30am – 6:00pm): 09 630 1961
- After-hours, weekends, and public holidays: 0274 820 763
In case of emergency, always call 111.