What is it?
It is a hospital-based procedure that can be in the outpatient (scheduled from the office) or in the inpatient setting (when the patient is already hospitalized).
Like the regular (surface) Echocardiogram, it utilizes high-frequency sound waves to provide pictures of the heart's valves and chambers. This helps the doctor evaluate the structure, pumping action of the heart and blood flow across the heart's valves.
Unlike the surface Echocardiogram, the transducer is mounted at the tip of a flexible tube (endoscope) that is introduced through the patient’s mouth and throat to the lower part of the esophagus and the upper part of the stomach. It is identical in size and general construction to an endoscope used by the gastroenterologist to study the upper gut, except that in place of a video camera and light, it employs an ultra-high frequency transducer to produce images on an external screen.
Why is it done?
Sometimes the surface echocardiogram is either of suboptimal or poor quality to visualize certain structures with adequate detail to make a diagnosis.
Certain conditions, such as a hole in the heart, infections of the heart valves or blood clots in chambers of the heart etc. can only be detected by this technique.
Several cardiac interventions require this detailed heart evaluation either before the procedure or during the procedure to guide device placement (such as heart valve replacement, ablation of arrhythmias, closure of holes in the heart etc.), ensuring procedural success.
How is it done?
It can be done either under moderate sedation or under general anesthesia.
Usually there is an anesthesiologist who helps the patient get sedated enough to allow the procedure to be done comfortably. The physician may spray the back of the throat with a numbing medicine to reduce gagging. A plastic bite-block is placed in the mouth to protect the teeth. For the usual evaluation, the procedure typically requires 5-10 minutes of sedation, followed by observation in recovery.
The physician evaluates the imaging as it is being done and makes the clinical decisions at the same time.
The physician may give the results to the patient (if the patient has recovered enough to be awake), but the results are generally given to the accompanying family or friend. They can be discussed in detail later with the patient, when the effects of sedation or anesthesia are no longer present.