93355 Echocardiography, transesophageal (TEE) for guidance of a transcatheter intracardiac or great vessel(s) structural intervention(s) (eg, TAVR, transcatheter pulmonary valve replacement, mitral valve repair, paravalvular regurgitation repair, left atrial ap

Name of the Procedure:

Echocardiography, Transesophageal (TEE) for Guidance of Transcatheter Intracardiac or Great Vessel(s) Structural Interventions

• Common names: TEE-guided structural heart intervention, TEE-guided cardiac procedure

Summary

Transesophageal echocardiography (TEE) is a specialized ultrasound imaging technique that involves inserting a probe into the esophagus to acquire detailed images of the heart. This procedure is often used to guide transcatheter intracardiac or great vessel(s) interventions, such as transcatheter aortic valve replacement (TAVR), transcatheter pulmonary valve replacement, mitral valve repair, and other structural heart repairs.

Purpose

TEE provides real-time imaging that aids doctors in precisely performing complex cardiac procedures. It is crucial for assessing the heart’s structure and function during interventions, ensuring accuracy and safety.

Indications

• Severe aortic or mitral valve stenosis or regurgitation
• Congenital heart defects requiring catheter-based repair
• Paravalvular leaks
• Left atrial appendage closure
• Patients who are high-risk for open-heart surgery

Preparation

• Patients are usually required to fast for 6–8 hours before the procedure.
• Medication adjustments may be needed, especially for blood thinners.
• Pre-procedure tests may include blood work, an electrocardiogram (EKG), and a standard transthoracic echocardiogram (TTE).

Procedure Description

1. The procedure starts with sedation to ensure patient comfort.
2. An ultrasound probe is gently inserted through the mouth and into the esophagus.
3. The probe captures detailed images of the heart and great vessels.
4. Real-time guidance is provided via these images as the transcatheter intervention is performed.
5. The probe is removed once the procedure is complete.

Tools and Equipment:

• TEE ultrasound probe
• Transcatheter devices (e.g., for valve replacement)
• Sedation and monitoring equipment

Duration

The entire procedure typically takes between 1 and 3 hours, depending on the complexity of the intervention.

Setting

TEE-guided procedures are usually performed in a hospital setting, particularly in an interventional cardiology or cardiac catheterization laboratory.

Personnel

• Interventional Cardiologist
• Cardiac Surgeon
• Anesthesiologist
• Nursing staff
• Echocardiography technician

Risks and Complications

• Common risks: Sore throat, minor bleeding
• Rare risks: Esophageal perforation, adverse reactions to sedation, infection
• Complications: Device misplacement, arrhythmias, stroke, or heart attack

Benefits

• Provides clear and detailed heart images, improving procedural accuracy.
• Real-time guidance helps minimize risks and enhance the safety of complex heart interventions.
• Outcomes can often be seen immediately or shortly after the procedure.

Recovery

• Post-procedure monitoring for several hours in a recovery area.
• Instructions on eating, drinking, and activity restrictions will be provided.
• Follow-up appointments are necessary to monitor heart function and procedural success.
• Recovery time varies; patients may resume normal activities within a few days but should follow specific medical advice.

Alternatives

• Transthoracic Echocardiography (TTE), though it may not provide the same level of detail.
• Open-heart surgery, which is more invasive and may carry higher risks and longer recovery times.
• Medical management with medications alone, suitable for less severe cases.

Patient Experience

• Sedation ensures minimal discomfort; patients generally feel relaxed and may not remember the procedure.
• Post-procedure, some throat soreness is common but manageable.
• Detailed aftercare instructions and pain management strategies will be provided to ensure a comfortable recovery.