Transoesophageal Echo


A transoesophageal echo procedure that uses a small probe positioned in the oesophagus and ultrasound (sound waves) to take close up images of your heart.

What is a Transoesophageal Echo?

During a transoesophageal echo or TOE a tube with a small probe is positioned in the oesophagus (your food pipe, the tube connecting your mouth and stomach). The probe uses ultrasound (sound waves) to take close up moving ultrasound images of your heart. A TOE is like an endoscopy performed by gastroenterologists.

Why has my cardiologist recommended a Transoesophageal Echo?

Your heart is made up of four chambers, separated by values that ensure blood flows through your heart in the same direction during each heartbeat. As the oesophagus runs down the back of your heart, a TOE provides our team with a closer look at the heart valves and chambers of the heart. Sometimes, extra information is needed that cannot be obtained from a standard echocardiogram either because there is interference from the ribs and lungs or because the structure sits at the back of the heart and can’t be seen clearly from the front.

A TOE is recommended when your cardiologist is concerned about:


  • Heart valve disease, such aortic stenosis or mitral regurgitation
  • Congenital heart disease
  • To further evaluate cardiac tumours and masses found on transthoracic echo
  • A hole in one of the walls separating the chambers of your heart
  • An infection of your heart valves
  • How your prosthetic valve is functioning
  • A guide for procedures such as cardiac ablation
  • To check for blood clots inside your heart prior to a cardioversion

What are the risks associated with a transoesophageal Echo?

A TOE is a common and safe procedure, but as with all procedures there are some risks associated.

The main risks your cardiologist will discuss with you before the procedure are:

  • Damage to the oesophagus, including bleeding or a tear (very rare, less than 1 in 20,000 procedures)
  • Sore throat following the procedure
  • Reaction to the sedative used to relax you, including nausea and difficulty breathing
  • Arrhythmia, heart attack or stroke (rare, usually < 1:1,000 chance)
  • Abnormally low or high blood pressure
  • Lower respiratory chest infection/pneumonia

Your individual risks will be discussed by your cardiologist before the procedure. They will depend on several factors including: your age; your other medical conditions and the reason for the TOE.

What should I expect when undergoing a transoesophageal echo?



Make sure your cardiologist is aware if you have previously had any problems with your oesophagus, such as a hiatus hernia, problems with swallowing, or cancer, including radiation treatment to the front chest area.

Avoid eating and drinking for at least six hours before the procedure.


At SouthWest Cardiovascular your TOE will be performed by a cardiologist who is highly trained in performing this procedure and has undergone additional specialist training in this field. For your convenience, all our procedures take place at St John of God in Bunbury. This procedure takes place in a specially designed cardiac procedure room. An anaesthetist will be present throughout your procedure to help the cardiologist. You will ‘sleep’ during the procedure, the anaesthetist will provide what is called ‘unconscious sedation’, which means you will not remember the procedure, but the sedation is not strong enough to make you stop breathing.

Either the cardiologist or a member of their team will:

  • Place three electrodes (small sticky patches) on your chest to monitor the electrical activity of your heart, a BP cuff on your arm to monitor your blood pressure and a small clip on your finger to monitor your oxygen levels.
  • Spray your mouth and give you solution to gargle to numb your throat (optional).
  • Place a cannula in your arm to administer sedation
  • Place a small plastic guard over your teeth so that you are unable to bite down on the tube/probe during the procedure
  • Insert a small thin lubricated endoscopy tube into your mouth, down the back of your throat and into the oesophagus (your food pipe). The tube will generally not interfere with your breathing
  • When in place, use the probe to obtain the required images of your heart using ultrasound (sound waves).
  • Remove the tube and probe once they have all the required images.

    You should expect the procedure to take between 15 and 30 minutes to perform.


    Following your TOE, you will be moved to the recovery ward to rest. You may feel a little tender in your throat for 1-2 days following the procedure
    You will be allowed to eat and drink once the numbness in your throat has gone.

    You will not be able to drive for 24 hours following the procedure, so it is advisable that you arrange to be collected by family or friends from St John of God Bunbury.

    A follow up appointment with your cardiologist will be scheduled where long term management and lifestyle advice will be discussed.