Diagnosis

Swallow echo

definition

A swallow echo is a special ultrasound examination of the heart. The ultrasound head is placed in the esophagus and from there the heart is scanned, which is located directly in front of it. The procedure is also called transesophageal echocardiography or TEE for short (English: transesophageal echocardiography).

In contrast to alternative ultrasound examinations of the chest (transthoracic echocardiography = TTE), the structure and functioning of the heart can be represented and assessed much better with the swallow echo, since there are no interfering structures such as lungs or ribs in the examination field.

The examination is often carried out under light sedation (twilight anesthesia). However, this is not absolutely necessary.

You might also be interested in: Anesthesia and sedation

Indications: When do you make a swallow echo?

A swallow echo is carried out in the diagnosis of various diseases of the heart.

These include, on the one hand, diseases of the heart valves. A distinction is made between a valve closure disorder (insufficiency) and a narrowing (stenosis). Whether or not one of these disorders is present can best be examined using swallowing echo.
In some cases, inflammation of the inner wall of the heart (endocarditis) can also be detected.
Congenital heart defects, such as a hole in the heart septum, can also be best identified with this examination.
In addition, TEE is used to detect or exclude blood clots within the heart. This has, for example, in the case of cardiac arrhythmias that are to be remedied by delivering electrical current (Cardioversion), an important meaning. Before such a measure there is always the indication for a swallow echo. The procedure may only be performed if no blood clots can be detected in the heart, as otherwise clots may spread. This could possibly result in a stroke.
Further indications for the swallowing echo exist in check-ups such as after the installation of an artificial heart valve and in the event that a previous ultrasound examination through the chest did not allow an adequate assessment of the heart.
In addition to the heart, the main artery (aorta) so that a possible bulging of the vessel (Aneurysm) is another indication for the swallow echo.

Preparation for a sip echo

In order to be able to perform a swallow echo, the patient must be sober. This means that you are not allowed to eat or drink anything for at least the previous six hours. If a sedative is to be administered, the patient is usually provided with a venous access in one arm. In addition, if the patient so desires, the throat can be anesthetized beforehand.

How does a sip echo work?

To perform a swallow echo, the doctor inserts a flexible instrument with the small ultrasound head at the end into the mouth esophagus a. Most patients find this beginning of the examination to be the most uncomfortable, so that a light local anesthetic of the throat may be appropriate. It is also possible that the patient is given soothing and drowsy medication beforehand.

After the ultrasound head has been inserted, the doctor can advance it within the esophagus to the level of the heart. This is where the actual examination begins with the ultrasound scan of the heart. The generated images are displayed in real time on a monitor.
With the help of the ultrasound device, the examiner can perform various measurements, among other things. As a rule, relevant images of the swallow echo are either printed or digitally recorded. The examination is finished after about 15 minutes and the ultrasound probe is carefully pulled out over the mouth.

Evaluation of the swallow echo

With a swallow echo, as with any ultrasound examination, there is a real-time display, i.e. the sound images made of the heart are shown directly on the screen.The evaluation of the TEE therefore begins with the examination itself.
For example, the examiner looks through all the heart cavities and looks for possible blood clots or inflammation-related deposits. Using various technical aids, the blood flow through the heart valves can also be measured and assessed with the ultrasound device. On the basis of the examination results obtained, the doctor can evaluate whether the valve function is normal or whether it is functioning properly.

Risks with the swallow echo

The swallow echo is a low-risk and quite harmless examination method.
The most common are temporary side effects such as discomfort and slight pain in the throat due to irritation from the examination instrument.

Serious side effects or complications only occur in extremely rare cases. These include, for example, cardiovascular or respiratory disorders. Injury to the wall of the esophagus, which can lead to bleeding and inflammation, is very rare. In extremely rare cases, surgery will have to be performed to correct the injury.

A possible alternative method of examining the heart is the MRI of the heart. It helps to identify functional disorders of the heart.
Read more about this at: MRI of the heart

How long does a sip echo last?

The duration of the actual swallowing echo examination is approx. 15 minutes. In addition, there are possible waiting times and discussions, for example with the doctor. In addition, it must be planned that if calming medication was administered for the examination, the patient may not be able to leave the practice or hospital straight away. If necessary, it is advisable to stay in a monitoring area until the effect wears off. We also recommend an adult accompanying person to pick up the patient.

Is Sedation Necessary?

Whether a swallow echo is carried out with or without sedation is primarily a matter for the patient. From a medical point of view, the calming medication can be dispensed with.

However, sedation may be useful for patients who are excited or anxious about the upcoming exam. So the patient doesn't notice much of the examination. In addition, the examination conditions and thus the quality of the results improve if the patient can lie down.
The disadvantage of sedation when performing TEE is that the patient is still drowsy and sleepy after the examination and therefore cannot leave the practice or hospital straight away. In addition, the patient must not be allowed to drive in traffic for 24 hours after sedation. An accompanying person is also required.

Anyone who allows the swallowing echo to be performed without sedation is in no way affected after it has ended and can go home immediately. There are also no restrictions or impairments when driving a car.

Whether sedation should be used must therefore be weighed against the advantages and disadvantages mentioned. The doctor performing the examination can support and advise the patient in this decision based on his experience.

Do you have to be sober for a sip echo?

An important prerequisite for a swallow echo to be performed is that the patient is sober. This means that you must not eat or drink anything at least six hours before the start of the examination. Even after the examination has been completed, food should not be consumed immediately, but only after about two more hours.

Cost of a swallow echo

A swallow echo is only performed by a doctor on medical advice. The costs incurred are then fully covered by both statutory and private health insurances.