Transesophageal

Transesophageal refers to approaches that use the esophagus to access nearby structures. In medicine, transesophageal echocardiography (TEE) is the most common form, using a flexible ultrasound probe inserted into the esophagus to obtain high-resolution images of the heart and surrounding mediastinal structures. The esophagus’s close proximity to the posterior heart allows clearer visualization of cardiac valves, chambers, and the aorta than some surface imaging.

Indications for transesophageal echocardiography include intraoperative monitoring during cardiac surgery (such as valve repair or replacement and coronary artery bypass), assessment of suspected endocarditis or intracardiac infection, evaluation of valvular disease and thrombus, and assessment of the proximal aorta for dissection or aneurysm. It is also used to guide percutaneous interventions and to obtain detailed imaging when transthoracic methods are limited, such as in patients with obesity or chest deformities, or when precise valve videos are needed.

The procedure involves fasting, sedation, and local pharyngeal anesthesia, followed by careful insertion of the probe into the esophagus under monitoring. The probe provides real-time ultrasound images of the heart from behind the silhouette, with continuous visualization by a trained echocardiographer. While highly informative, TEE is semi-invasive and carries risks such as esophageal injury, perforation, bleeding, aspiration, and throat discomfort. It is relatively contraindicated in patients with significant esophageal disease or recent esophageal surgery, and alternatives include transthoracic echocardiography or intracardiac imaging.