At a glance
Transesophageal echocardiography (TEE) is an ultrasound test that produces detailed images of the heart by sending sound waves from inside the food pipe (esophagus), which runs directly behind the heart.
A thin, flexible tube with a small ultrasound probe at its tip is guided down the throat and into the esophagus. Because the esophagus sits just millimetres from the heart, the images are much sharper than those taken through the chest wall. The sound waves bounce off heart structures and return as pictures on a screen, letting the cardiologist see the heart's chambers, valves, and major blood vessels in real time.
Medical Condition
Doctors order TEE when they need a clearer picture of the heart than a standard chest ultrasound (transthoracic echocardiography, or TTE) can provide, or when a patient's body shape makes surface imaging difficult.
- Suspected blood clots inside the heart, especially in a small pouch called the left atrial appendage, before procedures such as cardioversion (an electrical treatment to restore normal heart rhythm).
- Evaluating heart valve disease, such as a leaking or narrowed mitral valve or aortic valve.
- Investigating a possible hole between the heart's upper chambers, known as an atrial septal defect.
- Assessing the aorta (the main artery leaving the heart) for tears or enlargements called aortic dissection or aneurysm.
- Guiding surgeons or cardiologists during procedures such as valve repair or catheter-based heart interventions.
- Searching for a source of stroke or mini-stroke (transient ischaemic attack, TIA) that may have come from the heart.
- Checking the function of a prosthetic (artificial) heart valve.
- Monitoring heart function during open-heart surgery.
TEE is not suitable for every patient. The procedure requires passing a tube through the throat, so certain conditions make it unsafe or technically difficult.
- Severe narrowing or blockage of the esophagus.
- Recent surgery or active bleeding in the esophagus or stomach.
- Known or suspected tear in the esophagus.
- Severe instability of the neck spine that makes positioning dangerous.
- Uncontrolled bleeding disorders where sedation or the procedure itself would carry too much risk.
Risks & Complications
TEE is a low-risk diagnostic procedure, and serious complications are uncommon, but patients should know what can occasionally happen.
- Throat discomfort or mild soreness after the tube is removed, usually lasting a day or two.
- Temporary nausea or gagging during tube insertion, managed with throat-numbing spray and sedation.
- Reactions to the sedative medication, such as low blood pressure or brief breathing changes, monitored by the team throughout.
- Dental injury if teeth are not protected carefully during tube passage.
- Minor bleeding or small tears in the lining of the throat or esophagus, rare but possible.
- Significant esophageal perforation (a tear through the wall), very rare but the most serious potential complication.
- Temporary changes in heart rhythm (arrhythmia) triggered by the probe's position.
- Aspiration (breathing in small amounts of saliva), reduced by not eating before the test.
Preparation & Procedure
Preparation focuses on having an empty stomach and a settled throat so the probe can pass safely and the images are not obscured.
Patients are asked to stop eating and drinking for at least six hours before the procedure. Chewing gum and mints count as food. A small sip of water with essential medications is sometimes allowed, but the care team will give specific guidance based on each patient's situation.
Blood-thinning medications and diabetes medications may need to be paused or timed differently. Patients with dentures or removable dental work are asked to take them out before the test begins. Smoking and alcohol are best avoided in the days leading up to the appointment, since both can irritate the esophagus.
Before the procedure, the team usually runs a set of baseline checks. These may include a review of any previous heart tests, a brief physical check, blood tests to assess kidney function and clotting, and occasionally an X-ray or standard chest ultrasound.
The procedure itself follows a consistent sequence, though the exact steps and timing vary by hospital and patient.
- An intravenous (IV) line is placed in a vein in the arm to deliver sedation and fluids.
- A numbing spray is applied to the back of the throat to reduce the gag reflex.
- A sedative is given through the IV line. Most patients become drowsy and relaxed but remain able to breathe on their own.
- A protective mouth guard is placed to shield the teeth and hold the mouth slightly open.
- The lubricated probe is gently guided down the throat and into the esophagus, usually while the patient swallows.
- The cardiologist moves the probe to different positions and angles to capture images of the heart's structures from multiple views.
- Once all necessary images and recordings are taken, the probe is carefully withdrawn.
- The patient is moved to a recovery area to be monitored until the sedation wears off.
Aftercare
Most patients spend one to two hours in a recovery area after TEE while the sedation wears off and the team confirms that breathing and blood pressure are stable.
- Eating and drinking are usually restricted for about an hour after the procedure, because the throat-numbing spray takes time to wear off and swallowing too soon raises the risk of choking.
- A responsible adult must escort the patient home and stay with them for the rest of the day. Driving is not allowed for at least 24 hours after sedation.
- A mild sore throat or hoarse voice can persist for a day or two. Cold water and throat lozenges generally help.
- If swallowing becomes painful, worsens after going home, or is accompanied by fever, chest pain, or vomiting blood, the patient should seek medical attention promptly, as these could signal a rare esophageal injury.
- Normal activities can usually resume the following day, unless the findings lead to further procedures or hospital admission.
- The cardiologist typically discusses preliminary results the same day or soon after. A written report is usually shared with the referring doctor within a few days.
- Follow-up appointments depend entirely on what the TEE shows. Some patients need no further testing; others are referred for additional imaging, medication changes, or intervention.
Cost & What Determines It
The cost of TEE varies widely depending on where it is performed, what it is being used for, and how the hospital structures its billing. A routine outpatient TEE done to rule out a blood clot carries a very different price from one performed in an operating theatre while guiding a complex valve repair.
- Clinical complexity: a TEE ordered to monitor surgery in real time requires more personnel and longer probe use than a brief outpatient scan.
- Hospital class and country: private hospitals and internationally accredited centres typically charge more than public or government hospitals in the same country.
- Setting: an inpatient TEE performed during a hospital stay is billed differently from a procedure done in an outpatient cardiology suite.
- Sedation level: light conscious sedation costs less than deeper anaesthesia managed by an anaesthesiologist.
- Specialist fees: the cardiologist performing and interpreting the study may bill separately from the hospital facility fee.
- Ancillary tests: blood tests, a standard ECG (electrocardiogram, a tracing of the heart's electrical activity), or a baseline TTE ordered alongside the TEE add to the total.
- Medications given during or after the procedure, such as sedatives or throat-care products.
- Length of recovery monitoring, particularly if the patient needs extended observation.
Hospital packages for TEE, when offered, typically include the procedure itself, the use of the room and monitoring equipment, nursing care during recovery, and the cardiologist's interpretation report. Items that are commonly billed separately include the anaesthesiologist's fee, any additional imaging ordered after the findings, specialist consultations triggered by unexpected results, and pharmacy items.
BPJS Kesehatan and most Indonesian private insurance policies do not cover medical procedures performed abroad. Patients who travel overseas for TEE generally pay out of pocket or rely on international health insurance that explicitly covers treatment outside Indonesia. Before travelling, ask the hospital for a written cost estimate that lists each component separately. This makes it easier to compare options honestly and to plan for items that may be billed outside the main package.
Frequently Asked Questions
Does a TEE hurt?
Most patients feel mild discomfort in the throat rather than sharp pain, because the doctor passes a thin, flexible probe down the food pipe to get close-up images of the heart. You will be given a sedative to help you relax and a throat-numbing spray to reduce the gag reflex, so the procedure is much more tolerable than it sounds. Some people have a slightly sore throat for a day or two afterwards, but this usually settles on its own.
How do I prepare for a TEE? Do I need to fast?
Yes, you will need to avoid eating and drinking for several hours before the procedure, usually around four to six hours, so your stomach is empty and the sedative can be given safely. Your cardiology team will give you exact fasting instructions based on your scheduled time. If you take regular medications, ask your doctor whether to take them with a small sip of water on the day.
How long does a TEE take?
The imaging part of a TEE typically takes around fifteen to thirty minutes, but you should expect to spend one to two hours at the facility in total when you include preparation and recovery from the sedative. You will need someone to drive you home, because the sedative affects your coordination and reaction time for several hours after the procedure. Plan to rest for the remainder of that day.
How much does a TEE cost?
The cost of a TEE depends on several factors, including whether sedation is given, the class of hospital or clinic you choose, and whether the procedure is done as a standalone test or alongside other cardiac investigations. Specialist cardiologist fees and any monitoring equipment used during the procedure also affect the final figure. Requesting a written cost estimate from the hospital before booking is the clearest way to know what you will be charged.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
