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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
iASE

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.




February 2018

February question: The patient is a 29 y.o. female with a history of post partum cardiomyopathy. An LVAD was placed 1 yr. ago. She now presents for heart transplant. The donor ischemic time was short, and the aortic Xclamp was removed prior to SVC anastomosis with 1hr of reperfusion of the transplanted heart. After weaning from bypass on max pharmacological support, the TEE is shown. She was paced on VA ECMO. What is the problem, and what should be done?

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


Submit Your Answer Here



January 2018

January question: This patient was hypotensive following lung transplant for cystic fibrosis. In the first video, a trasgastic view of the RVOT and proximal PA is shown. In video 2, a midesophageal view of the RVOT is seen. What is going on?

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

Video 1 - TEE of the Month
Video'2'   (click to enlarge)


January answer: Cystic fibrosis has led to RVH; with the decrease in PVR afforded by 2 new healthy lungs, dynamic RVOT obstruction develops. Treatment included volume transfusion, and the decrease delivery of inotropic drugs.



December 2017

December question: This 69 year old patient with a lung mass was anesthetized in preparation for pneumonectomy via sternotomy. During the dissection he became hypotensive, refractory to medical management. Urgent TEE was performed as seen in the clips. He has no prior history of heart disease and no prior studies for comparison. What would be your course of action?

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

Video 1 - TEE of the Month
Video'2'   (click to enlarge)


December answer: In video 1, the left frame is a 4 chamber view showing lateral and septal hypokinesis, and in the right frame, anterior wall hypokinesis. In video 2, trans gastric imaging is seen; on the left at a midpapillary level, , only the inferior wall of the LV, and the RV free wall show contractile function. On the right, the apex is not contracting. These images are most consistent with a left main occlusion. The plan was to send him to the cath lab, but he was too unstable to transport. Since a sternotomy had already been performed, cardiac surgery came in and bypassed the LAD and circumflex arteries. Post op the wall motion had returned to normal.



November 2017

November question: In the first video, post op imaging of the mitral valve is shown; video 2 shows another postop image, quite different than preop; what’s going on?

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

Video 1 - TEE of the Month
Video'2'   (click to enlarge)


November answer: The initial video shows a successful mitral valve repair with ring annuloplasty. The image helps explain the subsequent findings. In the left hand frame, a midesophageal short axis shows the deformed LCC (better appreciated in real time), and the position of the annuloplasty ring which is not seen in 2D but seen in the representative 3D model from another patient (middle frame). The proximity of the 2 posterior aortic cusps and the annuloplasty ring are evident, explaining the complication seen: aortic valve entrapment by annuloplasty sutures placed too deeply. This highlights the importance of a complete exam following mitral valve surgery.

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





October 2017

October question: Video 1 shows the 4 chamber of a patient with posterior leaflet prolapse. After successful repair, the apteryx shows an unusual finding. What other information is important? What do you discuss with the surgeon? (Images courtesy of R. Ferreira, C. McFaul)

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

Video 1 - TEE of the Month
Video'2'   (click to enlarge)


Video 1 - TEE of the Month
Video'3'   (click to enlarge)


October answer: Answer Image 1 shows the preop TEE, revealing P2 prolapse. In Answer Video 1, the valve has been repaired with a P2 resection and ring annuloplasty, but there is a new structure indicated by the Asxterix. Although this is in the vicinity of the coronary sinus, it is clearly something else as it was not there preop. The most likely explanation is a left atrial dissection. This entity is usually seen in the setting of mitral valve surgery in the presence of a calcified annulus, which creates a defect allowing the dissection to propagate. Another way the defect can be created is during cannulation of a pulmonary vein for an LV vent, which was difficult, and I suspect, the culprit in this case. The optimal treatment is unclear; operative correction can be undertaken if there is secondary hemodynamic instability. Otherwise, a watch and wait approach may be justified. Post op TTE shows the area which now appears thrombosed.

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

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




September 2017

September question: In the first video, a suprasternal TTE is done, with the accompanying CW Doppler trace (first image). The second video shows a short and long axis midesophgageal view. The third video is a view of the proximal descending-distal aortic arch in long and short axis. What are the diagnoses?

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

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


Video 1 - TEE of the Month
Video'2'   (click to enlarge)

Video 2 - TEE of the Month
Video'3'   (click to enlarge)


September answer: This is an example of an aortic coarctation. The first video and image come from a suprasternal TTE view with Doppler evidence of a fixed gradient. Video 2 shows a bicuspid aortic valve which often coexists with aortic coarctation. Video 3 shows a TEE with the descending aorta just distal to the left subclavian artery, with aliasing of CD at the site of coarctation.



Summer 2017

Summer question: A fun question for the summer. Those of you with kids will be familiar with the "Fidget Spinner". I have rotated the spinner CLOCKWISE and acquired a video at 30 fps. At the same rotational speed (rpm) video was acquired at 240 fps. In Doppler echocardiography, what are the frames per second (fps) analogous to, and what phenomenon is being illustrated?

 

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


Summer answer: I have a link in which I try to answer the question; this pdf file has some great references.