TEE pictures furnished by Dr. Donald Oxorn, UW Anesthesiologist
Answer: This patient had bi-leaflet mitral valve prolapse (MVP), and had replacement with a St. Jude's bileaflet mechanical prosthesis. Surgeons try to preserve as much of the native apparatus as possible in order to minimize the effects on LV function. In this instance, residual tissue interfered with valve closure resulting in a large unilateral regurgitant jet; on the other side, the normal "cleaning jet" is seen. This redundant tissue was resected, and the jet disappeared.
Answer: The patient was a young woman with increasing exertional dyspnea, who was found on TTE to have a subaortic membrane. The Intraoperative TEE shown was obtained from the transgastric position at 81 degrees, and shows both the membrane and the aliasing of colour flow as it accelerates through the subaortic narrowing. A supplemental intraoperative Doppler revealed a significant gradient. When obtaining aortic gradients from the transgastric position, the operator must be parallel to outflow; I am the most confident when I can visualize the LVOT, aortic valve, and ascending aorta, and am parallel to all three with the Doppler beam.
Answer: This patient has muscular stenosis of the RVOT, with flow acceleration through the narrowing. RVH is also evident. A gradient of close to 100 mmHg was measured from a transgastric long axis view. This is a TEE image; because it closely resembles a transthoracic parasternal long axis, a number of people mistakenly identified this image as showing mitral insufficiency. A myomectomy was performed through the anterior wall of the RVOT with a satisfactory diminution of the gradient
Answer: Starr-Edwards Valve (ball-cage)
Answer: Rocking prosthetic aortic valve, with aortic root abscess, aorto-left atrial fistula.
Answer: Left ventricular assist device in place