Echocardiogram through the oesophagus

An echocardiography through the oesophagus allows for more detailed imaging of the heart. It involves the insertion of a tube, the endoscope, into the oesophagus, usually under a local anaesthetic. This is a flexible tube with a diameter of one cm.

In some cases, a contrast agent is administered using an IV line in the arm to check if the passage between the right and left atrium is open.

Preparation

The procedure requires you to have fasted. That means at least two hours for clear fluids (only water, tea and coffee), at least six hours for a light meal and dairy products and at least eight hours for a regular meal. You are allowed to take your regular medication with a drink of water.

If you have dentures, you will be asked to remove these before the examination.

To avoid complications, we ask you to inform us if any of the following applies:

• you are pregnant
• you have previously undergone surgery/radiation of the mouth, throat, oesophagus or stomach
• you have an allergy, sensitivity or intolerance (e.g. latex, Lidocaine)
• you have clotting issues or take blood thinners (e.g. Marevan®, Sintrom®, Marcoumar®, Ticlid®, Plavix®, Aspirin, Efient®, Pradaxa®, Xarelto®, Eliquis®)
• you have epilepsy or diabetes

Examination

Examination under local anaesthetic of the throat

You take place on the examination table and lie on your left side. Your throat is numbed using a spray and electrodes are placed on your chest to register the electrocardiogram. If required, an IV line will be placed in your arm to administer the contrast agent.

A special lubricant is applied to the endoscope. Then, the cardiologist will carefully insert the endoscope into your mouth. The cardiologist will ask you to swallow deeply to allow the endoscope to enter the oesophagus. It is important to continue to breathe calmly through your nose during the examination. The finer heart structures are visualised on the screen.

Examination under general anaesthetic

In exceptional cases, the examination may take place under general anaesthetic. This requires admission to the day hospital. The anaesthetic is administered by the anaesthetist through an IV in the arm. The examination itself is performed as described above.

The procedure is performed in an echocardiography room that is fitted with all the necessary anaesthesia equipment and endoscopy instruments. You will wake up in the echocardiography lab. Subsequently, you will be transferred to the Cardiology Day Hospital for further follow-up.

Aftercare

Examination under local anaesthetic of the throat

Because your throat has been numbed, you will have to wait until after the examination to eat or drink, due to the risk of choking. Approximately one-and-a-half hours after the examination, you may carefully try and take a sip of water.

Examination under general anaesthetic

If you opt for general anaesthetic, you will not be allowed to drive home on your own and you will need to take a day off work. Do not plan any important activities after the procedure. Your concentration and judgement may be impaired.

Contact us if you have any troubling symptoms such as persistent severe pain, fever, persistent bleeding, etcetera after the procedure.

Examination under local anaesthetic of the throat

If you choose a local numbing throat spray, you will be conscious during the examination. You may experience a light choking or gagging reflex. Your throat may remain irritated for some time after the procedure.

Examination under general anaesthetic

• After the procedure, you may experience throat irritation, mild drowsiness or dizziness as a result of the anaesthesia. Complications are rare for this procedure.
• A very rare complication is perforation (i.e. tear) of the oesophagus. In that case, you will need urgent surgery.
• Bleeding as a result of an echocardiography through the oesophagus is rare and can usually be treated without the need for surgery.
• Damage to teeth (especially if teeth are in poor condition) cannot be ruled out during an endoscopy or anaesthesia.

At the end of the consultation, the cardiologist will discuss the echocardiography findings with you as well as any resulting changes in your treatment.

Heart Centre

A dynamic team with expertise in treating heart problems

Cardiology

Heart and vascular disease

Latest publication date: 13/12/2023
Supervising author: Dr Provenier Frank