Anesthesiology & Pain Medicine >> Education >> TEE of the Month >> 2003 July – December
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Transesophageal Echocardiogram of July-Dec 2003

TEE pictures furnished by Dr. Donald Oxorn, UW Anesthesiologist

December 2003
Question: What TEE view is shown, and what does the arrow indicate?

Answer: The image is a high esophageal image which shows a thrombus in the right main
pulmonary artery. During pelvic surgery for tumor, the patient abruptly decompensated, and emergent CPB was instituted on the basis of the TEE. The mass was in fact embolized tumor.

The case report is published: Newkirk L, Vater Y, Oxorn D, Mulligan M, Conrad E. Intraoperative TEE for the management of pulmonary tumour embolism during chondroblastic
osteosarcoma resection. Can J Anaesth. 2003 Nov;50(9):886-90. [Full text]

November 2003
Question: In Figure 1, what is the abnormal image (??) seen beside the left atrium, and posterior to the left atrial appendage (LAA)?

( LUPV=left upper pulmonary vein, RVOT=right ventricular outflow tract)

Figure 1

November 2003 Image

Answer: The abnormal image is a persistent left SVC. Embryologically, the left sided cardinal veins disappear-when they do not, the result is a persistent left SVC, which drains into the coronary sinus, and is suspected when this latter structure is enlarged. It is important during cardiac surgery, as it renders retrograde cardioplegia ineffective. Persistent left SVC is diagnosed by the injection of agitated saline into a left arm IV; contrast appears in the coronary sinus before the right atrium (Figure 2).

Figure 2

November 2003 Image Answer
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October 2003
Question: What is pictured entering the ascending aorta?

Answer: The image shows the inflow cannula of a left ventricular assist device entering the ascending aorta.

October 2003 Animation
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October 2003 labels
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September 2003
Question: What is the most striking abnormality in this trangastric short axis view, of a patient with reduced cardiac index?

Answer: This patient had a remote stab wound to the chest and now presented with signs of left ventricular restriction. The TEE shows the lateral aspect of the LV to be infiltrated by a mass. At surgery, the mass was resected, and pathology revealed marked pericardial fibrosis with mild chronic inflammation and organizing debris, consistent with ancient hematoma.


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August 2003
Question: Based on the angle of interrogation, what is the pathologic process in this 60 year old patient who presents with acute worsening of shortness of breath?

Answer: There is severe flail of the anterior mitral leaflet. In this bicommisural view (Left Figure), the mid to medial portion of the anterior mitral leaflet is flail, secondary to a torn cord. There was severe mitral insufficiency.

Animation

Bicommisural view

TEE Animation
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Bicommisural view
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July 2003
Question: What is the nature of the acute aortic pathology seen in this 75 year old male's aortic arch?

Answer: This is an image of the aortic arch. There is an intimal defect and a thrombosed pseudoaneurysm. The etiology is unclear; there was a history of remote trauma, but there was ulcerated plaque seen at the time of repair, and this probably represents a penetrating atherosclerotic ulcer.


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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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