Anesthesiology & Pain Medicine >> Education >> TEE of the Month >> 2003 January – June
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Transesophageal Echocardiogram of of Jan-June 2003

TEE pictures furnished by Dr. Donald Oxorn, UW Anesthesiologist

June 2003
Question: Define the lesion in this image of the tricuspid valve

Answer: This patient had a long standing pacer lead that had become adherent to the tricuspid valve. The patient had anterior leaflet tricuspid prolpase, with elongated cords seen in the right atrium, and severe TR. Tricuspid valve replacement was performed.


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May 2003
Question: This 68 year old male presented with severe back pain and shortness of breath. What do the images reveal?


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Answer: This individual had a type "B" dissection. The false lumen is clotted, although colour Doppler still shows flow from true to false lumens. In the bottom left hand corner of the image on the left, a left pleural effusion is seen-the patient had bled into his left hemithorax. Urgent surgical repair was undertaken.


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April 2003

 

Question: what structure on the animation (seen on the left) is represented by question mark on the still (seen on the right)

Answer: The image shows the aortic arch with the innominate vein in front of it. The
clip shows the effect of injecting agitated saline into an IV in the left arm. This is an
important diagnostic manouver as this presentation is sometimes mistaken for an aortic
dissection.


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March 2003
Question: The 2 clips are typical of what congenital lesion?

Answer: The lesion is a primum ASD. The first video clip shows the ASD, and the second clip shows MR through a cleft anterior leaflet, a consistent feature.

First Clip

Second Clip


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February 2003


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Question: This 68 year old female presents in cardiogenic shock and pulmonary edema-what is the diagnosis?

Answer: This image proved difficult to interpret, because it is an unorthodox view. It is from the stomach, with the probe strongly anteflexed, so that it resembles a transthoracic apical 4 chamber. As is seen from the still, a communication exists between the LV and RV. When the clip is played next to a clip without color, the LV apex is seen to be infarcted and aneurysmal, and to communicate with the RV as is seen by the color flow pattern. The post infarct VSD was closed with a pericardial patch.

January 2003
Question: What congenital defect has been repaired? Comment on each of the 3 frames.

Answer: The patient had a tetralogy of Fallot repaired. The frame on the left shows the RV and RVOT where a substantial amount of muscle has been resected. The middle frame shows the patch neutralizing the over-riding aorta and eliminating the VSD. Colour flow in the right hand frame shows an intact repair.


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