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Transesophageal Echocardiogram of the Month

TEE pictures furnished by Dr. Donald Oxorn, UW Anesthesiologist

You might also like to visit the Canadian Society of Echocardiography-Cardiomath Echo Calculator

For those with smartphones or iPads I recommend the following apps as excellent reference guides. The first is from the University of Toronto (same folks who brought you the Virtual TEE website) and the next 3 are from the American Society of Echocardiography

TEE Standard Views on Apple iPad App icon

iTunes Preview

Echo AUC App icon

American Society of Echocardiography
Echo AUC

iTunes Preview

ASA Pocket Guidelines App icon

American Society of Echocardiography
ASE Pocket Guidelines

iTunes Preview

iASE App icon

American Society of Echocardiography

iTunes Preview

Now available:

coming later in 2016

(click image to enlarge)

Book purchase allows the individual to utilize the Inkling platform on tablets and smart-phones to view full text and videos.

May 2019

May question: Identify the different signals in this mitral inflow CW Doppler

Image 1 - TEE of the Month
Image'1'   (click to enlarge)

Submit Your Answer Here

March 2019

March question: Following a Bentall procedure for aortic dissection, the LV function in this 34 year old male with Marfan's syndrome is normal. (Video 1) His postoperative course was accompanied by hemodynamic stability but ongoing issues with postoperative delirium. He returned to the OR for thoraco-abdominal completion of his procedure, the the following TEE images (videos 2 and 3) are obtained. What are  the possible explanations for the change?

Video 1 - TEE of the Month
Video'1' (click to enlarge)

Video 2 - TEE of the Month
Video'2' (click to enlarge)

Video 3 - TEE of the Month
Video'3' (click to enlarge)

March answer: The dramatic change implies an acute process. The young age of the patient makes coronary disease very unlikely; however the previous procedure on the aortic root may have interfered with coronary flow. That being said, the wall motion abnormalities make little sense vis a vis coronary distribution.

The most likely explanation is Takotsubo cardiomyopathy, a poorly understood entitiy somehow related to acute stress. The proposed mechanisms of this unique syndrome of reversible cardiomyopathy include: 1.epicardial coronary artery vasospasm; 2. coronary microvascular impairment; 3. direct catecholamine-induced myocyte injury and/or 4. neurogenic stunned myocardium. Unfortunately this patient died during his second procedure, whether the cardiomyopathy had a part to play is unknown.

Takotsubo cardiomyopathy.
Mahdi Veillet-Chowdhury, Syed Fahad Hassan & Kathleen Stergiopoulos

(2014) Takotsubo cardiomyopathy: A review, Acute Cardiac Care, 16:1, 15-22, DOI:


February 2019

February question: This patient had a calcified bio prosthetic aortic valve explanted and replaced with a Perceval©️valve. What is demonstrated by the deep trans gastric video and Doppler tracings?

Image 1 - TEE of the Month
Image'1'  (click to enlarge)

Video 1 - TEE of the Month
Video'1'  (click to enlarge)

February answer: Starting with the spectral Doppler- On the left, the cursor cuts through the interventricular septum, and the ascending aorta. There are 3 signals of note: 1. A broad systolic jet moving towards the transducer in systole-although this looks like a TR jet might, it is going in the wrong direction.The colour Doppler helps as it shows primarily a systolic jet moving from the LV to the RA side of the tricuspid valve- a "Gerbode" type of VSD, in this case, iatrogenic 2.There is a low velocity jet moving away from the transducer during systole;This second systolic jet probably arises from the ascending aorta. 3. There is a diastolic jet.., and the diastolic jet is probably from the paravalvular AR jet the cursor is seen cutting through.

On the right, the spectral Doppler cursor is seen going through the tricuspid valve, and the systolic jet is a TR jet judging by its position and direction.

Video 1 - TEE of the Month
Answer Image'1'   (click to enlarge)


January 2019

January question: After you see the video, can you explain why there might be high RV systolic pressure, but much lower PA systolic pressure?

Image 1 - TEE of the Month
Image'1'  (click to enlarge)

January answer: This patient with pulmonary hypertension has an elevated PVR and subsequent right ventricular hypertrophy; the PVR is dramatically reduced with the lung transplant. The patient developed RVOT obstruction akin to lowering the SVR in someone with HOCM. The pulmonic valve is normal and the RV-PA gradient is solely due to the muscular sub valvular obstruction. Treated with fluids and the elimination of inotropic/chronotropic drugs.