Concierge cardiology imaging · London
Transoesophageal echocardiogram (TOE), high-resolution echo from the oesophagus — closer to the heart, sharper images.
A transoesophageal echocardiogram (TOE / TEE) is a specialised echo performed via an ultrasound probe in the oesophagus — bypassing chest wall and lungs for sharper images of valves, atria, aorta, prosthetic devices and left atrial appendage.
Why patients choose us
- 01
The right hands
We route you to a consultant cardiologist accredited in transoesophageal echocardiography — the person passing the probe reads the study.
- 02
Day-case pathway
Fasted arrival, sedated study, structured plan and discharge — the same day.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Key facts
The six things worth knowing about TOE.
What the study is, what it can — and cannot — settle, and how it fits alongside TTE and cardiac MRI.
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Definition
A specialised echocardiogram performed with an ultrasound probe passed into the oesophagus — bypassing chest wall and lungs for high-resolution images of the heart.
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Consultant cardiologist-led
Performed and reported by a consultant cardiologist trained and accredited in transoesophageal echocardiography.
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Conscious sedation (midazolam / fentanyl)
A short-acting intravenous sedative and, where needed, an opioid — you are drowsy but rousable throughout.
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Day-case
A half-day pathway: fast, cannulate, sedate, scan, recover, home the same day with a written plan.
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Sharper than TTE for valves and LAA
Because the probe sits directly behind the heart, TOE gives sharper views of valves and the left atrial appendage than a transthoracic echo.
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Complements TTE and cardiac MRI
TOE is a complement to — not a replacement for — the transthoracic echocardiogram and cardiac MRI.
The diagnostic pathway
From consultation to plan — what happens, in order.
One consultant cardiologist from consent through to the report — a half-day pathway.
- 01
Cardiology consultation
A consultant cardiologist reviews the indication, symptoms, comorbidities and prior imaging, and confirms TOE is the right test.
- 02
Fasted 6 hours
Nil by mouth for 6 hours before the study — clear fluids may be permitted up to 2 hours before, per unit protocol.
- 03
IV cannulation + sedation
A peripheral cannula is sited and short-acting conscious sedation (midazolam / fentanyl) is titrated to comfort.
- 04
Throat local anaesthetic
A topical lidocaine spray is applied to the oropharynx to suppress the gag reflex.
- 05
Probe passed to oesophagus
A slim ultrasound probe is passed via the mouth, over the tongue and into the oesophagus in the left lateral position.
- 06
Standard TOE views
A structured set of mid- and lower-oesophageal and transgastric views images the valves, chambers, aorta, appendage and any prosthetic devices.
- 07
Structured plan
Findings are discussed once you are awake, with a formal written report and onward cardiology, surgical or MDT pathway.
Typical end-to-end: half a day. Urgent cases: same day.
What it shows
What a TOE can — and cannot — settle.
The clinical questions where the transoesophageal view materially changes what a standard echo can offer.
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Prosthetic valve function
Detailed assessment of mechanical and bioprosthetic valve leaflets, gradients and paravalvular leak.
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Left atrial appendage thrombus (pre-cardioversion)
The definitive imaging test to exclude LAA thrombus before elective cardioversion for atrial fibrillation.
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Infective endocarditis vegetations
Higher sensitivity than TTE for valve vegetations, abscess and prosthetic-valve endocarditis.
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Aortic dissection
Rapid bedside characterisation of ascending, arch and descending thoracic aortic dissection.
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Atrial septal defect (ASD)
Sizing, rim assessment and haemodynamic characterisation of atrial septal defects prior to closure.
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Patent foramen ovale (PFO) with bubble study
Right-to-left shunt detection with agitated saline contrast — the reference test for PFO after cryptogenic stroke.
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Mitral valve prolapse detail
Segment-by-segment characterisation of prolapsing scallops to plan mitral repair or MitraClip.
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Red flag: aortic dissection — urgent thoracic surgery
A dissection flap on TOE is a surgical emergency — direct handover to the on-call cardiothoracic team.
Next steps
What follows a TOE — the treatment options.
The plan sits between the TOE findings, the clinical picture and the MDT — not a single default answer.
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Cardioversion for AF (post-TOE)
Once LAA thrombus is excluded, elective DC or chemical cardioversion can proceed the same day where indicated.
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Anticoagulation optimisation
Review and adjustment of DOAC or warfarin therapy in light of TOE findings and stroke-risk score.
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Valve surgery / TAVI / MitraClip
Structured referral to the surgical or structural cardiology MDT for valve repair, replacement or transcatheter intervention.
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PFO closure
Percutaneous PFO closure in selected patients with cryptogenic stroke and a right-to-left shunt.
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ASD closure
Percutaneous or surgical closure of a haemodynamically significant atrial septal defect.
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Endocarditis IV antibiotics
Prolonged intravenous antibiotic therapy under an endocarditis MDT, with surgical review where indicated.
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Cardiac follow-up
Structured cardiology follow-up with interval TTE, TOE or cardiac MRI as clinically appropriate.
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MDT review
Complex valve, endocarditis and congenital cases are discussed in a formal multidisciplinary meeting before any intervention.
Red flags
When a TOE finding — or a complication — needs urgent escalation.
Some findings and post-procedure symptoms need same-day surgical or emergency review. These are the ones we look for first.
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Aortic dissection
A dissection flap on TOE is a cardiothoracic-surgical emergency — direct handover to the on-call team.
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LAA thrombus + AF
Thrombus in the appendage contraindicates cardioversion — anticoagulate and rescan.
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Endocarditis with valve dehiscence
A dehisced prosthetic valve or root abscess needs urgent surgical review.
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Prosthetic valve dehiscence
New paravalvular leak or rocking motion of a prosthesis is a surgical emergency until proven otherwise.
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Post-cardioversion embolism
New neurology after cardioversion — 999, urgent stroke pathway, not a routine follow-up.
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Aspiration during probe insertion
A rare but serious complication of sedated probe insertion — head-down suctioning and airway support.
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Anaesthetic complication
Sedative-related over-sedation, hypotension or respiratory depression — reversal agents and monitoring.
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Oesophageal perforation (rare)
Very rare (~0.02–0.03%) but catastrophic — chest pain or subcutaneous emphysema after TOE needs urgent CT and thoracic surgery.
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Post-procedure pain with fever
Persistent throat or chest pain with fever after TOE is not routine — same-day review to exclude perforation or mediastinitis.
Reading your report
A TOE report can look intimidating. It isn’t.
Whatever the finding, the report keeps to the same four parts.
A quiet reminder
The report is written for your doctor, not for you — and that’s normal.
If you would like us to talk you through it before your follow-up, just ask.
- 01 Header
Indication and clinical context
Your details, the reason for TOE, sedation used and any complications encountered.
- 02 Technique
Probe, views and contrast
Which probe, which mid- and lower-oesophageal and transgastric views, and whether agitated-saline bubble contrast was used.
- 03 Findings
Chambers, valves, aorta, appendage
Chamber-by-chamber and valve-by-valve description, aortic assessment, LAA and any prosthetic devices.
- 04 Impression
The conclusion: read this first
The headline finding — thrombus, endocarditis, dissection, PFO — and the concrete next step. Read this first.
Sources
The guidance that anchors this page.
Reviewed on 2026-07-30. Next scheduled review 2027-07-30.
Recognised by major UK insurers
Cover depends on your policy and clinic; we confirm with your insurer before booking.
Frequently asked
Everything we get asked about TOE.
Quick answers on sedation, fasting, duration, safety and what happens afterwards.
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What is a transoesophageal echocardiogram (TOE)?
A specialised echocardiogram performed with an ultrasound probe passed via the mouth into the oesophagus. Because the probe sits directly behind the heart, it produces sharper images of the valves, atria, aorta, prosthetic devices and left atrial appendage than a standard transthoracic echo (TTE).
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Is a TOE painful?
The study is performed under conscious sedation with midazolam (and often fentanyl) and topical throat anaesthetic. Most patients remember very little of the procedure and describe it as briefly uncomfortable rather than painful.
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Do I need to fast?
Yes — nil by mouth for 6 hours before the study. Clear fluids may be permitted up to 2 hours beforehand depending on your unit’s protocol.
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How long does a TOE take?
The scan itself typically takes 15–30 minutes. Allow half a day for the full pathway: consent, cannulation, sedation, scan and monitored recovery before discharge.
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Can I drive home?
No. Because of the sedation you must not drive, operate machinery or sign legal documents for 24 hours. You will need a responsible adult to collect you and stay with you overnight.
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How safe is a TOE?
TOE is a very safe test in experienced hands. Serious complications — most importantly oesophageal perforation — are rare (roughly 0.02–0.03%). Minor sore throat is common and usually settles within 24 hours.
Related
Looking for a different test?
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Echocardiogram
The standard transthoracic echo — first-line cardiac ultrasound.
Learn more -
Bubble echocardiogram
Agitated-saline contrast echo to detect right-to-left shunts and PFO.
Learn more -
Contrast echocardiography
Microbubble contrast echo for chamber definition and myocardial perfusion.
Learn more -
All tests
Browse every test and procedure we arrange.
Learn more -
Hypertension
Related condition guide.
Learn more -
Atrial Fibrillation
Related condition guide.
Learn more -
Coronary Angioplasty
Related treatment option.
Learn more -
Coronary Artery Disease Treatment
Related treatment option.
Learn more
In practice, in London
Booking transoesophageal echocardiogram privately in London — what actually happens
With transoesophageal echocardiogram, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. Waiting lists on the NHS for transoesophageal echocardiogram vary widely by borough and by how the GP letter reads. Privately in London, we can normally offer a slot inside the same week, sometimes within 48 hours if there’s a cancellation. The difference isn’t clinical quality — the consultants are frequently the same faces you’d see on the NHS — it’s the calendar.
Once you’re in the private system for transoesophageal echocardiogram, the pace picks up noticeably. Consultant slots run to time, imaging is usually available in the same building or a short walk away, and the report comes back typed and detailed. It’s the coordination that tends to feel different — one person on the other end of the phone, not a switchboard. For transoesophageal echocardiogram specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
Where a good concierge earns its keep is in the matching. There are dozens of consultants in London who see transoesophageal echocardiogram — but not all of them are the right fit for every case. We narrow it down based on subspecialty, insurer coverage, the specific question being asked, and whether continuity into treatment matters. The right first appointment saves you from repeating yourself later.
Nearby in the library