Guide to Requesting TOEs

Specialists in Cardiology

Dr Kon Profitis
MBBS, FRACP

When should you consider ordering a Transoesophagheal Echo

For your patient?
Although transthoracic echocardiography (TTE) remains the cornerstone of diagnostic cardiac ultrasound, transoesophageal echocardiography (TOE) is a valuable complementary tool. As compared with TTE, TOE offers superior visualisation of posterior cardiac structures because of their close proximity to the oesophagus. With the recent breakthrough technology of 3D imaging, TOE is now able to deliver even more superior images of certain cardiac structures such as the mitral valve.

Indications for TOE:

Detection of a suspected source of embolism
TOE is superior to TTE for visualisation of left atrial appendage, atrial septum, thoracic aorta and prosthetic valves and hence is used with increased frequency for evaluating suspected intracardiac source of embolism. Findings linked to cardiac embolisation include aortic atheroma, patent foramen ovale (PFO), left atrial thrombus, spontaneous echo contrast and atrial septal aneurysm.

Infective endocarditis
There is no debate about TOE being the procedure of choice in the evaluation of suspected endocarditis or its complications. TOE has been clearly shown to be superior to TTE in the diagnosis of vegetations and complications of endocarditis, such as an abscess and fistula formation.

Valvular heart disease
TOE provides excellent characterisation of valvular pathology. It is valuable in evaluation of valvular regurgitation and provides vital information to cardiac surgeons when deciding repair versus replacement of the valve. TOE is considered imperative in the assessment of prosthetic valve dysfunction, especially the mitral valve.

Detection of intracardiac masses
TOE is invaluable in the characterisation and localisation of intracardiac masses such as thrombus, myxoma and other tumours.

Congenital heart disease and intracardiac shunts
Conditions such as atrial septal defect, atrial septal aneurysm, patent foramen ovale, anomalous.