Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); image acquisition, interpretation and report only
CPT4 code
Name of the Procedure:
Echocardiography, Transesophageal, Real-Time with Image Documentation (2D) Common name(s): Transesophageal Echocardiogram (TEE)
Summary
A Transesophageal Echocardiogram (TEE) is a diagnostic test that uses ultrasound waves to create detailed images of the heart. The procedure involves passing a flexible tube with an ultrasound probe down the patient's esophagus to get closer to the heart for clearer images.
Purpose
TEE is used to diagnose and evaluate various heart conditions by providing high-resolution images of the heart's structure and function. The primary goals are to detect abnormalities, guide surgeries, and monitor heart disease progression.
Indications
- Unexplained chest pain or discomfort
- Suspected heart valve disease
- Congenital heart defects
- Atrial fibrillation or other arrhythmias
- Prior stroke, to check for blood clots or sources of emboli
- Intraoperative monitoring during cardiac surgery
Preparation
- Fasting for at least 6 hours before the procedure
- Informing the doctor of any medications; certain blood thinners may need adjustment
- Pre-procedure diagnostic tests such as a standard transthoracic echocardiogram (TTE)
Procedure Description
- The patient lies on their side on an examination table.
- Local anesthetic is applied to the throat to minimize discomfort.
- Sedation is administered intravenously to help the patient relax.
- A flexible tube with an ultrasound probe is gently guided down the esophagus.
- Real-time images of the heart are captured and recorded.
- The procedure usually completes with the patient slowly waking from sedation.
Duration
The whole procedure typically takes 30 to 60 minutes.
Setting
TEE is performed in a hospital or specialized outpatient clinic equipped with advanced ultrasonic imaging systems.
Personnel
- Cardiologist specialized in echocardiography
- Echocardiography technician
- Anesthesiologist or nurse trained in sedation management
- Support nursing staff
Risks and Complications
- Throat discomfort or sore throat post-procedure
- Potential reaction to sedation
- Rare risks include esophageal perforation, bleeding, or aspiration
- Immediate response to any adverse reaction by the medical team
Benefits
- Highly detailed images of cardiac structures not visible through routine echocardiograms
- Essential information for accurate diagnosis and treatment planning
- Immediate results in some cases, with definitive interpretations typically within 24 hours
Recovery
- Observation until sedatives wear off, typically 1-2 hours
- Instructions to avoid eating or drinking until the throat numbness subsides
- Avoid driving or operating machinery for the rest of the day
- Follow-up appointments for discussing results and further care
Alternatives
- Transthoracic Echocardiogram (TTE): Non-invasive but may offer less detail.
- Cardiac MRI or CT Scan: Alternative imaging modalities with varying levels of detail and different risk profiles.
- Physical examination and stress tests: Less invasive but with limited structural information.
Patient Experience
- Discomfort or gagging sensation when the tube passes the throat
- Managed pain and anxiety through anesthesia and sedation
- Post-procedure throat soreness
- Potential for mild sedation effects like drowsiness or unsteadiness after the procedure