What is a TOE?

A TOE is a heart scan that uses ultrasound (sound waves) to produce extremely detailed images of the heart. It is often used to look carefully at the valves and the structure of the heart and is usually carried out under sedation.

You must be accompanied home from your appointment by a friend or relative to have a TOE procedure as it involves sedation. If you are not accompanied by a friend or relative, you will not be able to have the sedation.

How is a TOE done?

You will be invited into a private treatment room. Three people will usually be present to perform the scan: a doctor and two cardiac physiologists. You will be asked to undress to the waist and put on a gown that should be left open to the front. You will be asked to lie on a couch on your back.

Stickers will be attached to your chest and connected to the echocardiogram (scan) machine. These will be used to monitor your heart rate during the test. Your blood pressure will also be checked regularly throughout the procedure. A needle (cannula) will be inserted into a vein in your left arm to provide the sedation and oxygen will be given via your nose.

You will be given some local anaesthetic sprayed on the back of your throat and then asked to lie on your left-hand side. You will be awake for the procedure but feel less discomfort due to the sedation.

You will then be asked to swallow the TOE probe (tube). This part may cause discomfort, but it is not painful. Recorded images of the heart will then be obtained. The part of the test will take about 20 minutes.

At the end of the procedure, the tube will be removed, your blood pressure will be checked again, and you will be allowed a short period of recovery.

During the procedure the light will be dimmed, and you will hear sounds coming from the machine. What you are hearing is the blood flow through the heart. The TOE can take up to 60 minutes from start to finish to complete. Please allow up to five hours in total for your procedure and recovery.

Before your TOE

  • Do not eat or drink anything for six hours before the test.
  • Normal medication should be taken on the morning of the TOE with a small sip of water. Please bring a copy of your prescription with you.
  • If you are diabetic, please inform the nurses as soon as you arrive for your appointment.
  • If you are on warfarin, please have your INR checked within seven days prior to the test and bring the result of the INR with you.
  • Please inform the department if you have any problems with swallowing, or if you have had any bleeding from your stomach. This may prevent the TOE from being performed.
  • If you have dentures, you will be asked to remove them before the test.

After your TOE

You will continue to be monitored after your TOE. When you are fully alert and the sensation has returned to your throat, you will be allowed a drink. This usually takes about one and a half hours.

You will be allowed home when you are fully alert (approximately two to three hours after the procedure). If you have been given sedation, you should not drive or operate heavy machinery for the remainder of the day.

Risks and side-effects

The stickers used can cause a skin reaction. If you have an allergy to skin adhesive or plasters, please let us know.

You may have a sore throat after the procedure lasting for one to two days. Occasionally the throat may bruise or bleed slightly.

There is an extremely small risk (less than 1 in 10,000) of damaging or tearing the oesophagus (the tube connecting your mouth to your stomach). In extreme circumstances this may require an operation to repair the damage.