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Specialist services available:-

Transoesophageal Echocardiogram

Introduction

Transoesophageal echocardiography (TOE) is a procedure that enables the Doctor to obtain very clear ultrasound pictures of your heart from within your oesophagus and stomach. It permits closer access to the heart and is ideal for looking at the heart valves, aorta and structures at the back of the heart. It is particularly useful for identifying preformed clots within the heart that may prevent invasive procedures of the heart.

Preparation

• You will need to fast for at least 6 hours before the test from both food and fluids. • Take your regular medications unless otherwise instructed by your Doctor. • If you are diabetic you will need to consult your Doctor. • You will also need to arrange for somebody to drive you home after the procedure. The sedation you receive during the procedure makes it unwise for you to drive. • Please notify your Doctor if you have an artificial heart valve, have had a previous valve infection or are going to have a mitral valve repair as you may require antibiotic cover. Tell your Doctor if you are allergic to any antibiotics. • Please tell your Doctor if you have ever experienced any difficulties swallowing, if you have had previous radiotherapy to your chest or if you have had any problems with your oesophagus previously that may make passage of the probe difficult. • Please tell your doctor if you are pregnant.

What Happens During Your TOE ?

Dr Sharpe prefers to perform the TOE under a light anaesthetic often refered to as a ‘twilight anaesthetic’. You will not be aware of the procedure itself. When you arrive for your test you will be given a local anaesthetic spray or gargle, which will make your throat numb. A sedative may be given which will make you drowsy and may take away some memory of the test. You should not drive for 12 hours after the procedure. The back of your throat will be anaesthetised and your swallow reflex may be impaired. It is important therefore that you do not swallow excess saliva. Your ability to swallow will be tested by the Nursing Staff in the recovery area with a small sip of water. If you have no problems swallowing this you may then eat and drink normally.

Risks of TOE

The risk of complications is very low and will be discussed with you by the Cardiologist performing the procedure. Based on a reported series of over 10,000 cases these include: • Breathing complications; inhalation of stomach contents – less than 1 in 1,000. • Damage or perforation of the oesophagus ‐ less than 1 in 1,000. • Death – frequency less than 1 in 10,000. • A sore throat and minor bleeding may occur in the following day or so.

Intracardiac Echocardiogram (ICE)

Intracardiac echo is a special sterile single use ultrasound catheter is inserted through the femoral vein up into or near the heart. It enables high resolution real tim imaging of all the internal structures of the heart. It is used in minimally invasive structural heart repair such as atrial septal defect (ASD), patent foramen ovale (PFO), left atrial appendage closure, and electrophysiology procedures. The advantage is that the patient does not need to sedated or anaethetised to perform the procedure like the TOE.