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Cardiolucent

Procedure

Transesophageal Echocardiogram (TEE)

High-resolution ultrasound from inside the esophagus

A transesophageal echocardiogram (TEE) is an ultrasound study performed with a small probe passed gently into the esophagus, which sits just behind the heart. Because the probe is millimeters from the heart rather than across the chest wall, image quality is dramatically better than a standard transthoracic echo — making TEE the test of choice for evaluating valve anatomy, suspected endocarditis, blood clots in the left atrium, and many congenital lesions. The procedure is performed under sedation at the hospital.

What's Included

  • High-resolution 2D and 3D ultrasound of the valves and chambers
  • Color Doppler and spectral Doppler flow analysis
  • Detailed evaluation for left atrial appendage thrombus
  • Endocarditis vegetation detection
  • Pre- and post-procedural assessment for structural interventions
  • Conscious sedation administered by the procedural team
  • Detailed report and personal review with Dr. Kedan

How It's Performed

TEE is performed in a hospital echo lab or procedural suite, typically at Cedars-Sinai. After IV sedation, your throat is numbed and a flexible probe is passed through the mouth into the esophagus. The ultrasound team captures a comprehensive set of images over 15 to 30 minutes. You will not feel the probe once it is in place, and most patients have little or no memory of the procedure afterward.

How to Prepare

  • Nothing to eat or drink for at least 6 hours before the procedure.
  • Arrange a driver — you cannot drive home after sedation.
  • Bring an updated medication list, including blood thinners.
  • Tell the team about any swallowing problems or prior esophageal disease.
  • Take routine medications with a sip of water if instructed, otherwise hold them.

What to Expect After

You will spend 30 to 60 minutes in the recovery area until the sedation wears off. A mild sore throat lasting a day or two is common. You can resume a normal diet once your swallow reflex is fully back, usually within an hour. Dr. Kedan reviews the study personally and walks you through the findings, images, and any recommended next steps at a follow-up visit.

Indications

  • Suspected infective endocarditis
  • Detailed valve assessment when transthoracic images are limited
  • Suspected left atrial appendage thrombus before cardioversion or ablation
  • Search for a cardiac source of stroke or systemic embolism
  • Pre- and intra-procedural imaging for structural heart interventions (TAVR, MitraClip, LAA closure)
  • Evaluation of prosthetic valves
  • Suspected aortic dissection or aortic disease

Common Questions

Frequently Asked Questions

What is a TEE and how does it differ from a regular echo?
A standard transthoracic echo (TTE) takes ultrasound images from the chest wall. A transesophageal echo (TEE) places the ultrasound probe in the esophagus, just behind the heart. The closer vantage point produces dramatically higher-resolution images — especially of the valves, left atrium, and aorta — and is the test of choice when fine anatomic detail matters.
Why would I need a TEE instead of a TTE?
TEE is selected when a question can't be reliably answered from the chest wall. Common reasons include evaluating heart valves in detail, ruling out endocarditis (heart-valve infection), looking for a blood clot in the left atrial appendage before cardioversion or ablation, searching for a cardiac source of stroke, and guiding structural procedures like TAVR or LAA closure.
Where is the procedure done?
TEE requires sedation and procedural support, so it is performed at Cedars-Sinai or another affiliated hospital echo lab. Dr. Kedan coordinates scheduling and integrates the result back into your overall plan.
How long does it take?
Image acquisition is typically 15 to 30 minutes. With check-in, IV placement, sedation, and recovery, plan on roughly 2 to 3 hours from arrival to discharge.
Is it painful?
No. Your throat is numbed and you are sedated, so you should feel little to nothing during the procedure. Most patients have no memory of it afterward. A mild sore throat for a day or two is the most common after-effect.
How do I prepare?
Nothing to eat or drink for at least 6 hours before the procedure, arrange a driver to take you home, and bring a complete medication list. Dr. Kedan and the procedural team will give you specific instructions about which medications to hold.
What are the risks?
TEE is very safe in experienced hands. Rare risks relate to the sedation and to the probe passing through the esophagus — sore throat, transient hoarseness, and very uncommonly esophageal injury. The procedural team monitors you continuously.
What will the report show?
Detailed measurements and images of each valve, chamber sizes and function, blood-flow patterns, and answers to the specific clinical question — for example, presence of a clot or vegetation. Many TEEs now include 3D imaging that gives anatomy a surgeon's eye view.
When will I get my results?
Preliminary findings are often discussed in the recovery area. The final report is available within 24 hours, and Dr. Kedan reviews it personally and walks you through the findings at a follow-up visit.
How do I schedule one?
Call Cardiolucent at (310) 304-5555. Dr. Kedan determines whether TEE is the right next test based on your evaluation and coordinates the procedure at Cedars-Sinai.

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Medical Disclaimer

The information on this site is for general educational purposes only and is not medical advice, diagnosis, or treatment. Reading this site does not create a doctor–patient relationship. Always consult a qualified healthcare professional for personal guidance. If this is an emergency, call 911. Mentions of medications, devices, or procedures are informational and not endorsements. Full medical disclaimer.

†Some listed indications involve investigational/off-label use. Learn more.