Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report
CPT4 code
Name of the Procedure:
Transesophageal Echocardiography for Congenital Cardiac Anomalies (TEE)
Summary
Transesophageal echocardiography (TEE) is a specialized ultrasound procedure used to obtain detailed images of the heart and its structures. Instead of using a traditional ultrasound probe on the chest, this procedure involves guiding a flexible probe down the esophagus to capture high-resolution images of the heart from within the chest cavity.
Purpose
TEE is primarily used to diagnose and assess congenital heart anomalies—structural problems with the heart that are present from birth. The goal of the procedure is to provide high-quality images of the heart's valves, chambers, and adjacent vessels, allowing for accurate diagnosis and planning of potential treatments or surgeries.
Indications
- Unexplained heart murmurs.
- Symptoms of congenital heart disease (e.g., shortness of breath, cyanosis).
- Pre-surgical assessment for congenital heart anomalies.
- Monitoring of known congenital heart defects.
- Inconclusive results from transthoracic echocardiography (TTE).
Preparation
- Patients are typically instructed to fast for 6-8 hours prior to the procedure.
- Adjustments to medications, especially those affecting blood clotting, may be necessary.
- Pre-procedure assessments often include a routine physical exam and blood tests.
Procedure Description
- Sedation: The patient is given sedatives or, occasionally, general anesthesia to ensure comfort.
- Probe Placement: The throat is numbed with a local anesthetic spray. The TEE probe, a flexible tube with an ultrasound transducer at the tip, is gently guided down the esophagus.
- Image Acquisition: Using real-time ultrasound imaging, the probe captures detailed images of the heart and related structures.
- Interpretation: The images and video clips are reviewed by a cardiologist to diagnose congenital cardiac anomalies.
- Report: A comprehensive report summarizing findings and potential recommendations is generated.
Duration
The procedure typically takes about 30 to 60 minutes, though the total time including preparation and recovery can be 1.5 to 2 hours.
Setting
TEE is usually performed in a hospital setting, often in a specialized echocardiography or cardiology unit equipped to handle advanced diagnostic procedures.
Personnel
- Cardiologist
- Anesthesiologist or sedation nurse
- Ultrasound technician
- Registered nurse (RN)
Risks and Complications
- Risk of bleeding or infection from probe insertion.
- Esophageal injuries, such as tears or perforations.
- Reactions to sedation or anesthesia.
- Transient sore throat or hoarseness.
Benefits
- Provides high-resolution images for accurate diagnosis.
- Helps in detailed assessment of congenital heart defects.
- Aids in surgical planning and monitoring.
- Minimally invasive with relatively low risks.
Recovery
- Patients are monitored for a few hours post-procedure.
- Instructions typically include avoiding food and drink until the throat numbing agents wear off.
- Sore throat and mild discomfort are common but usually resolve quickly.
- Return to normal activities is often possible within a day, but follow-up visits might be required.
Alternatives
- Transthoracic echocardiography (TTE): Less invasive but may not provide as detailed information.
- Cardiac MRI or CT scan: Non-invasive advanced imaging but involves radiation (in CT) and may require contrast agents.
- Cardiac catheterization: More invasive and involves radiation exposure but offers both diagnostic and therapeutic capabilities.
Patient Experience
- Patients typically remain relaxed but may feel mild throat discomfort during the procedure.
- Conscious sedation ensures minimal distress, but patients might experience grogginess afterward.
- Post-procedure sore throat and a sensation of bloating due to air introduced during the procedure are common but temporary.