TEE pictures furnished by Dr. Donald Oxorn, UW Anesthesiologist
Answer: The images show the insertion of the right upper pulmonary vein into the SVC, rather than the normal situation of the left atrium. This anomalous drainage is often in the setting of a sinus venosus ASD. This patient had a sinus venosus ASD repaired as a child, and now presented with right sided volume overload. Occasionally anomalous pulmonary veins insert into the IVC and coronary sinus in this condition.
Answer: This is an image of an intraaortic balloon pump (IABP). This device is used to improve coronary perfusion and afterload reduce the left ventricle. The balloon should deflate in systole and inflate in diastole. In the present example, the balloon inflates in systole, and would therefore be extremely counterproductive. The patient was still on cardiopulmonary bypass when balloon inflation was initiated, and was rectified before coming off bypass.
Image courtesy of Ray Liao, MD
Answer: The abnormality in the left atrium is cor triatriatum, which develops from failure of resorption of the common pulmonary vein resulting in a left atrium divided by a fibromuscular diaphragm into a posterosuperior and
anteroinferior chambers. The posterosuperior chamber, also called accessory left atrial chamber or pulmonary venous chamber, receives the pulmonary
veins whereas the anteroinferior chamber, also
known as the true left atrium, gives rise to the left
atrial appendage and communicates with the mitral
orifice. Communication between both chambers is
through one or more fenestrations of the left atrial
membrane. The degree of obstruction is determined
by the size of the fenestration(s). (See Tantibhedhyangkul, W. et al. J Am Soc Echocardiogr 1998;11:837-40.).
Answer: The prebypass clip shows concentric LVH with preserved systolic function. After
the mitral valve repair and ring annuloplasty, the transgastric imaging shows
systolic anterior motion of the anterior mitral leaflet (SAM).CW Doppler through
the LVOT shows the typical sawtooth pattern of dynamic outflow tract
obstruction, with a peak gradient of 52mmHg.
February 2005 (Images courtesy of Jorg Dziersk, MD)
Answer: The TEE on the left shows a transgastric short axis view of the LV. The posterolateral wall is the only one working and the inferior wall is dyskinetic following this acute MI. In the clip on the left, the apex is frankly necrotic, with a VSD-this must be closed prior to placing an LVAD to prevent potential aspiration of air and other debris from the RV to the LV during ventricular emptying into the device.
Answer: Panel "A" shows a massively dilated coronary sinus in a patient
who had had previous surgery for tetralogy of Fallot. The hint in panel "B" is
a large persistent left superior vena cava (PLSVC). Whenver the coronary sinus
is enlarged, a PLSVC should be looked for-it is usually seen abutting on the
lateral border of the left atrium. The presence of a PLSVC and enlarged
coronary sinus have implications for central line placement, and for the
administration of retrograde cardioplegia. The diagnosis is confirmed by the
administration of agitated contrast through a left arm vein, and noting
appearance of the contrast in the coronary sinus first, and the right atrium