Anesthesiology & Pain Medicine >> Education >> TEE of the Month
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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.




October 2018

October question: This 25 year old female had, 7 years prior to the current presentation undergone an ascending aortic replacement form the STJ just proximal to the innominate artery, and valvuloplasty of her bicuspid valve. 6 months prior to her current admission, she suffered a CVA -- her workup for PFO, MAC etc. was negative. There was no history compatible with AFib. The CVA resolved, and the TEE of the ascending aorta is shown. What are your thoughts?

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



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Summer 2018

Summer question: We were recently confronted with this problem. 67 year old female with severe AS, CAD and Ef of 20% undergoes AVR with bileaflet mechanical prosthesis. Long pump run, limps off bypass. The TG SA LV is shown, as is the deep transgastic of the aortic prosthesis. RV systolic function is also depressed. It is clear that despite industrial doses of inotropic agents and pressors, her hemodynamics and low SvO2 suggest that she will not survive in the current state. What are the considerations, and what would be your next move?

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

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



Summer answer: At this point, the patient was fairly unstable, with compromised ventricular function. I was unclear if the failure of one of the mechanical aortic valve leaflets was not moving because it was stuck, or because the flow through it was so low. It was elected to put her on VA ECMO. As she recovered , the valve was still not opening, She was taken back to the OR, where tissue probably form the thickened mitral annulus was interfering with aortic valve function. The valve re-replaced, with a satisfactory result. 

The leaflets of a mechanical, bileaflet valve are fairly easy to appreciate in the mitral position, but less so in the aortic position. I interrogate the valve in the deep transgastric position, and rotate the angle of interrogation until both leaflets are visible; usually works.



June 2018

June question: From the image (PLEASE NOTE; A TTE), calculate and assess as many parameters of MR severity as possible.

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


June answer: Here are the derived indices:

Continuity with PISA for ERO determination
2πr2 x aliasing vel. = MR peak vel. X ERO
6.28 x (0.6 cm)2 x 34.6 cm/sec = 573 cm/sec x ERO
78 cm3/sec = 573 cm/sec x ERO
0.14 cm2 =ERO

Regurgitant Volume
ERO x MR VTI = RV
0.14 cm2 x 232 cm = 32 ml

Regurgitant Fraction
MR SV / MR SV + LVOT SV = RF
32 ml / 32 ml + (3.14 x 1 cm2) x 22.3 cm = RF
32 ml / 32 ml + 70 ml = RF
31% = RF

April 2018

April question: This patient presented to the cath lab for an intervention; based on what is seen in the first three images (pre intervention) and the second two (post intervention) what was done and what was the complication? (Images courtesy of Carly Peterson MD, Coleen McFaul MD, Dane Ingebrigtson MD)

Image 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 1 - TEE of the Month
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Video 1 - TEE of the Month
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April answer: This patient with Rheumatic mitral stenosis presented for Balloon valvuloplasty; unfortunately the posterior mitral annulus was ruptured resulting in severe MR. Valve replacement was ultimately required.



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)


February answer: The segmental wall motion abnormality indicates a left main coronary artery issue. The patient was taken to the cath lab where intense spasm of the LMCA was seen; intra-arterial NTG resolved the issue.


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


 


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.