Is it Really That Hard to Have a "Local TEE" Done (vs. Dr. Natale)?

I had the Watchman put in by Dr. Natale in April and had my first TEE with him in July. Everything is going great but I'm supposed to have my second TEE (the 6th month checkup) in late October/early November.

I'd like to avoid having to travel to Austin, TX yet again, especially that time of year since we have a lot going on then so I'm considering doing it locally.

How hard is it to have these TEE's done locally? I know Dr. Natale is picky about the images, but if you find someone locally that has a lot of experience doing TEE's after Watchman implants, I have to believe they'll take the specific images Dr. Natale needs to see so it shouldn't be that hard, or am I off base on this?

I'm just trying to figure out if having the next TEE locally is possible. I live in the Twin Cities area of Minnesota (Minneapolis/St. Paul). If it's a pain in the butt then I suppose I'll suck it up and take another trip to Austin.

Travis

Talk to Natale's office. It's possible they can recommend someone in your area, and if not I believe he's accepting CTAs now in lieu of a TEE and those can be done almost anywhere.

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Carey
Talk to Natale's office. It's possible they can recommend someone in your area, and if not I believe he's accepting CTAs now in lieu of a TEE and those can be done almost anywhere.

Yep, he recommended a CTA for me he doesn’t know any cardiologist in my city and he has received a lot of poorly done TEEs that had to be redone in Austin.

Dr Natale rather grudgingly agreed for my post Watchman TEE here in Charlotte. My EP does the Watchman and they have a TEE Specialist who received Austin s protocol and then provided them the scan. Mine was perfect per the TEE been 18 months now since Dr Natale placed my Watchman

I wanted to update my original post. After many back and forth communications with Dr. Natale's office and my local EP's office, we have a local CTA Chest scheduled. I'm thrilled because it will save a lot of money and time doing this locally here in MN vs flying to Austin for a "simple" TEE checkup.

I'm a bit nervous because my local EP's team wasn't terribly familiar with this approach. They do TEEs as a follow up to Watchman devices and don't normally do CTA Chest scans with contrast dye. There was a lot of back and forth to ensure everyone was on the same page and that they (my local EP's team) were scheduling the appropriate procedure. They didn't say this specifically, but I got the sense that they thought it was "strange" to do a CTA chest scan in lieu of a TEE, but they went along with it since it's coming from Dr. Natale.

What I wonder about is if these CTA chest scans are preferred over TEEs when these check ups are done outside of Austin, TX, why don't they just tell us that out of the gate? I think they should tell you that your first checkup will be a TEE in Austin and then the subsequent check ups can be done locally with CTA chest scans.

And it also begs the question, why doesn't Dr. Natale's team just do CTA chest scans for all Watchman follow ups? Why even bother with the TEE? The CTA chest scan sounds like a piece of cake. They told me I just had to show up 15 minutes before the scan. They'll hook me up to an IV for the contrast dye and then x-ray me, which takes just a few minutes. Then I'm done! There's no sedation, recovery, etc. Seems to me they should just do CTA chest scans for everything and skip the TEE's all together...unless I'm missing something.

At any rate, my local CTA chest scan is scheduled for late October. I'll be sure to post my experience here in the forum when it's done.

Travis

They told me in Austin that the TEE was better for seeing certain things and the CTA for others, but that it was best to get a TEE for the first check. I was told when I got my Watchman that, though I would need to come to Austin for the first TEE, I could get CTAs locally for the 6 month and 1 year check ups.

The advantage a TEE has is it shows motion. You can see heart wall movement in real time AND blood flow because it's a doppler device. So that allows them to see volume, velocity, and turbulence of blood flowing through the heart. That's particularly important at the first TEE when they're especially concerned with finding any leaks.

Ah. Makes total sense. Thanks for the explanation!

Travis

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Carey
The advantage a TEE has is it shows motion. You can see heart wall movement in real time AND blood flow because it's a doppler device. So that allows them to see volume, velocity, and turbulence of blood flowing through the heart. That's particularly important at the first TEE when they're especially concerned with finding any leaks.

Interesting. When I was there my ONLY option was to come to Austin, TX for all the TEEs. When I asked if it was possible to have any of them done locally, they said that I could have the 2nd and 3rd TEE locally but they would prefer if they were all done in Austin. They strongly advised I at least have the first TEE done there. There was no mentioning of CTAs after the first TEE. In fact, I didn't know the CTA was even an option until I started communicating with them to coordinate getting the second TEE scheduled here locally.

Travis

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Daisy
They told me in Austin that the TEE was better for seeing certain things and the CTA for others, but that it was best to get a TEE for the first check. I was told when I got my Watchman that, though I would need to come to Austin for the first TEE, I could get CTAs locally for the 6 month and 1 year check ups.

When I got my Watchman in 2018 it wasn't an option then either. They said I could get one locally and they would be happy to send their requirements to the doctor doing it, but odds were they wouldn't get what they wanted and I'd have to fly to Austin and do it over. So I skipped the do-over and flew to Austin. CTA wasn't an option in 2018.

TEE is in motion, real time and another advantage is that TEE produces no radiation. Chest CTA is static and with radiation.

Travis,

Do you not remember? I answered this for you long ago and I had a very successful and detailed TEE in my hometown because there are many watchman providers here and they follow the watchman protocol for the TEE. As a matter fact, it was way more detailed than the reports I had an Austin. My only complaint was that they use more anesthesia than just proopofol and I didn’t know they would do that. It was sent to Doctor Natale hours after having it done and he read it and had no problems whatsoever with the report. I just had it 7/31/23.

When I had my TEE at Robles hospital, a satellite hospital for dr Natale, he didn’t do the 6 week tee or others that followed. I had to use random doctors, some not an EP, all approved by Natale’s office. Because I had an emergency watchman because I had a GI bleed, Natale did a tee after placement of the watchman so I could stop eliquis for 5 days to get a colonoscopy. He doubled check I was not leaking before stopping eliquis.


So as far as I know,,he doesn’t perform routine tees at Robles- I speculated it is lack of time since he is only here Wednesday afternoons to Fridays and left Saturday mornings. Maybe he only concentrated on utilizing his time on ablations- I don’t know. I did try to schedule with him. The 9 month tee lasted 7 minutes from anesthesia to waking up.