Anesthesiology & Pain Medicine >> Education >> TEE of the Month >> 2004 July – December
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Transesophageal Echocardiogram of July-Dec 2004

TEE pictures furnished by Dr. Donald Oxorn, UW Anesthesiologist

December 2004
Question: In this mid esophaeal view with the probe anteflexed, what does each number correspond to?

Answer: 1 is the left main coronary artery, 2 is the LAD, and 3 is the circumflex. This view was obtained in short axis just above the aortic valve. Best views of the RCA are seen by imaging the aortic valve and ascending aorta in long axis, and originating from the right coronary sinus of Valsalva.

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November 2004
Question: This clip is a short axis cut through the proximal ascending aorta. What is the structure seen, and is a regurgitant or stenotic lesion more likely the result?

Answer: Image 1 is the cross sectional view of a circumferential dissection flap in the ascending aorta. The new clip taken (Image 2) with the probe advanced, shows the flap interfering with aortic valve function resulting in aortic regurgitation.

Image 1

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Image 2

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October 2004
Question: What is the abnormality at end diastole of the anterior mitral leaflet, what is its cause, and what is the associated eponym?

Answer: The first clip shows a fluttering anterior mitral leaflet during diastole, and the second clip reveals the cause-aortic regurgitation. This produces the Austin-Flint murmur-a diastolic murmur heard in the mitral position. An M-mode nicely shows the anterior leaflet fluttering.

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Question Images

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Animated Image 1

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Animated Image 2

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September 2004
Question: What is the abnormal structure indicated by the double arrow in the figure on the left? (A clue is found in Image 2 on the right, indicated by the single arrow.)

Answer: The structure is n aberrant coronary artery. The clue in image 2 is the large right coronary orifice. At a later coronary catneterization, the circumflex was seen to arise from
the right coronary.

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Sept 2004 TEE image animation

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Image 2

Sept 2004 TEE still image

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Answer

Sept 2004 TEE still image

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August 2004
Question: What is the origin of the 2 images indicated by arrows in the still? An m-mode is included.

Answer: This is a reflection artifact of the descending aorta with a dissection. If one examines the M-mode, it is seen that the 2 linear images are exact mirror images which suggests the diagnosis.

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August 2004 TEE image animation

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August 2004 TEE

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M-Mode Image

August 2004 TEE m-mode image

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July 2004
Question: What does the bright image seen in the still(arrow) and video clip represent?

Answer: This is a classical example of a reverberation artifact. The Mitral valve has been replaced by a St Judes bileaflet mechanical prosthesis, although in this view, only one leaflet can be seen. The bright mobile image defined in the still, is a reverberation originating from it. Note how the 2 images move in complete synchrony. The "clutter" of images between the 2 mentioned above is scatter seen typically with a mechanical prosthesis.

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July 2004 TEE image animation

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July 2004 TEE image #2

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