Indications for a TEE

For those interested in performing TEEs, it is crucial to know the appropriate indications for TEE as well as the risks associated with the procedure. These are outlined on below. 

Finding a cardiac source of embolus

TEE can be done in select patients with stroke that appears cardioembolic. Careful assessment of all valves, the left atrial appendage, the intra-atrial septum and the aorta for large friable atheroma are all important components of this study.

Assessing for a cardiac source of infection 

After an initial work-up for endocarditis TEE can be used sometime to help make a diagnosis in those with reasonable clinical suspicion or to help triage a case of known or suspected endocarditis to medical vs. surgical therapy, if for example an abscess is seen. 

Imaging the heart before, during and after major cardiac surgery

Often immediately after cardiac surgery transthoracic echo windows are inadequate because of recent inflammation and chest tubes and a TEE is needed. In those undergoing complicated bypass and/or valve surgery pre-op and intra-operative, TEE can help guide surgical therapy.

Assessment of and intracardiac shunts.

Certain congenital anomalies such as ASDs or anomalous pulmonary venous return can be better seen by TEE. 

Pre-cardioversion in those with atrial fibrillation for flutter

Here the left atrial appendage and atrial and ventricular structures are close examined for the presence of thrombus before cardioversion.  This is often the most common indication in many institutions.

Assessment of an intracardiac masses 

TEE can better characterize location of intracardiac masses seen initial on TTE. Cardiac MRI is also a convenient modality for this evaluation but TEE may be better for visualization of smaller, more higly mobile lesions.

Examination for a proximal aortic dissection 

When other imaging modalities are impractical because the patient has renal failure or not able to get a CT or MRI, TEE becomes the test of choice.