Patients that require heart valve surgery or in situations where standard echocardiography provides limited information, a more advanced study known as TOE (Trans Oesophageal Echo) is performed. The procedure is performed in CCU at Rotorua Hospital. Patients will be requested to be nil by mouth from midnight the night before, some patients will be requested to stop blood thinning medication.  A spray is used to numb the back of the throat, and sedation is given to make you sleepy. The ultrasound probe is then inserted into the gullet/food pipe/oesphagus, as it sits close to the heart we get much clearer pictures to help diagnose the problem or help guide surgical decisions.