Transesophageal echocardiography (TEE) places a miniaturized ultrasound transducer on the tip of a gastroscope-like probe that is passed into the esophagus, providing posterior imaging windows to the heart without the acoustic interference of ribs, lungs, and chest wall. TEE achieves substantially higher image quality than transthoracic echo for posterior cardiac structures and is essential in several clinical scenarios.
TEE indications include atrial fibrillation cardioversion (ruling out left atrial appendage thrombus), native and prosthetic valve assessment, endocarditis evaluation, aortic dissection detection, congenital heart disease, and intraoperative cardiac monitoring during valve repair, cardiac surgery, and TAVR procedures. The cardiac sonographer assists by probe manipulation, image optimization, and measurement acquisition while the cardiologist or anesthesiologist manages the procedure and sedation.
TEE proficiency requires RDCS credentials and specific training in TEE probe handling, multiplane imaging, and the TEE image set acquisition protocol. Cardiac sonographers perform TEE in cardiology procedure suites, cardiac catheterization laboratories, and cardiac surgical operating rooms. Advanced competency in real-time 3D TEE is increasingly expected in tertiary cardiac programs.