Anesthesiology & Pain Medicine >> Education >> TEE of the Month
Shortcut www.uwanesthesiology.org/echo

Transesophageal Echocardiogram of the Month

TEE pictures furnished by Dr. Donald Oxorn, UW Anesthesiologist

You might also like to visit the Canadian Society of Echocardiography-Cardiomath Echo Calculator

For those with smartphones I recommend this app as an excellent reference guide.

ASA Pocket Guidelines App icon

American Society of Echocardiography
ASE Pocket Guidelines

iTunes Preview

For better viewing, and the ability to alter the speed of the clip, drag the video clip to the desktop, and open with Quicktime or equivalent.



December 2011

December Question:  This patient had previous mitral valve surgery and now presented with acute onset of severe shortness of breath. What is the diagnosis?


Video 1 - December 2011 - Tee of the Month
Video '1'   (click to enlarge)

Video 2 - December 2011 - Tee of the Month
Video '2'   (click to enlarge)



December Answer:  This patient had a remote mitral valve repair with ring annuloplasty. As can be seen, the native leaflets are still present, but the ring has dehisced posteriorly. The MR is central through the native leaflets, and goes through the gap between the native annulus and the ring. In the strictest sense, this is not "perivalvular MR" as it is not outside the mitral valve, but just goes around the displaced ring.


Answer Image - December 2011 - Tee of the Month
Answer Image   (click to enlarge)



November 2011

November Question:  This patient presented with a single GSW to the back, and a cold pulseless leg.
Representative TEE images are displayed. What is the diagnosis?
(Images courtesy of Dr. Sally Barlow FANZCA)

(The case is from the volume “Intraoperative Echocardiography” edited by Donald Oxorn { View Book Cover }.
This is one of a series of 4 volumes from the “Practical Echocardiography Series” edited by Catherine Otto, and soon to be published by Elsevier.)


Video 1 - November 2011 - Tee of the Month
Video '1'   (click to enlarge)

Video 2 - November 2011 - Tee of the Month
Video '2'   (click to enlarge)



November Answer:  The bullet traversed the left atrium and penetrated the non coronary sinus; because of the small caliber, the velocity of the bullet decreased sufficiently in the aorta to be propelled into the femoral artery. At surgery, the posterior wall of the left atrium was adherent to the posterior chest wall, and there was no pericardial effusion. The left atrium and non coronary sinus were repaired, and the bullet extracted from the femoral artery.



October 2011

October Question:  What's wrong with this picture? (Image courtesy of Dr. Gary Monteiro.)

For those of you who use Philips machines, use the video clip on the left; for those of you who use Siemens/Acuson machines, use the video clip on the right (Video 2).

(The case is from the volume “Intraoperative Echocardiography” edited by Donald Oxorn { View Book Cover }.
This is one of a series of 4 volumes from the “Practical Echocardiography Series” edited by Catherine Otto, and soon to be published by Elsevier.)


Video 1 - October 2011 - Tee of the Month
Video '1'   (click to enlarge)

Video 2 - October 2011 - Tee of the Month
Video '2'   (click to enlarge)



October Answer:  I hate to be a stickler, but here it goes. In panel "A", the Philips machine, and Panel "B", the Siemens machine, the icons indicated by the arrows are opposite to what they should be (see image below). In fact, this is a patient with Situs Inversus.


Answer Image - October 2011 - Tee of the Month
Answer Image   (click to enlarge)



September 2011

September Question:  In the video and corresponding image, what do the numbers indicate?
(Images courtesy of Dr. A. Schroeder and Dr. G. Monteiro)

(The case is from the volume “Intraoperative Echocardiography” edited by Donald Oxorn { View Book Cover }.
This is one of a series of 4 volumes from the “Practical Echocardiography Series” edited by Catherine Otto, and soon to be published by Elsevier.)


Video 1 - September 2011 - Tee of the Month
Video '1'   (click to enlarge)

Image 1 - September 2011 - Tee of the Month
Image '1'   (click to enlarge)



September Answer:  1. is clearly the descending aorta in short axis. 2. is a pericardial effusion-we know this because the fluid insinuates between the aorta and left atrium. 3. is a pleural effusion, as it is NOT between the heart and aorta. 4. is an artifact; it moves in perfect synchrony with the aorto-lung interface. On examination, in crosses the border between the 2 effusions.



August 2011

August Question:  This 60 year old woman with no coronary disease nor other significant comorbidities presents for mitral surgery. Videos 1 and 2 demonstrate the mitral valve abnormality. Following surgery, severe LV failure was noted. Videos 3, 4, and 5 reveal postop mitral views, and the Doppler tracing (August image 1) is taken from a deep transgastric view.

What is the clinical scenario?

(The case is from the volume “Intraoperative Echocardiography” edited by Donald Oxorn { View Book Cover }.
This is one of a series of 4 volumes from the “Practical Echocardiography Series” edited by Catherine Otto, and soon to be published by Elsevier.)


Video 1 - August 2011 - Tee of the Month
Video '1'   (click to enlarge)

Video 2 - August 2011 - Tee of the Month
Video '2'   (click to enlarge)


Video 3 - August 2011 - Tee of the Month
Video '3'   (click to enlarge)

Video 4 - August 2011 - Tee of the Month
Video '4'   (click to enlarge)

Video 5 - August 2011 - Tee of the Month
Video '5'   (click to enlarge)

Image 1 - August 2011 - Tee of the Month
Image '1'   (click to enlarge)

book cover image
Book Cover  (click to enlarge)



August Answer:  Videos 1 and 2 show bileaflet mitral valve prolapse, and a colour jet that is largely central but with an anterior component which suggests some uneven leaflet apposition, Video 3 shows that the valve has been replaced with a bioprosthesis. However, video 4 shows systolic anterior motion of the anterior mitral leaflet remnant which was left behind in an effort to preserve LV systolic function. Video 5 shows colour compatible with velocity acceleration in the LVOT, and a degree of MR which is normal for this valve prosthesis. Image 1 shows the typical Doppler configuration of dynamic LVOT obstruction. The remnant was subsequently resected with resolution of the gradient.



July 2011

July Question:  Following a double lung transplant, the patient was not oxygenating well, and frothy sputum was coming out of the left bronchial orifice of the double lumen tube. Video 1 shows colour Doppler from the patient, and image 1 is a normal image from another patient in which the arrow serves to indicate the structure from which the colour flow from video 1 was originating. Pulse wave Doppler from the patient is shown in image 2.

What is the clinical scenario?

(Case courtersy of Mark Edwards, Auckland, New Zealand. The case is from the volume “Intraoperative Echocardiography” edited by Donald Oxorn. {July image 3} This is one of a series of 4 volumes from the “Practical Echocardiography Series” edited by Catherine Otto, and soon to be published by Elsevier.)


Video 1 - July 2011 - Tee of the Month
Video '1'   (click to enlarge)

Image 1 - July 2011 - Tee of the Month
Image '1'   (click to enlarge)


Image 2 - July 2011 - Tee of the Month
Image '2'   (click to enlarge)

Image 1 - July 2011 - Tee of the Month
Image '3'   (click to enlarge)



July Answer:  The flow acceleration is in the left upper pulmonary vein. The highly stylized picture (Figure-July answer 1) shows the preparation of the donor pulmonary veins for anastamosis. Panel "A" is an en face view looking into the donor left atrial cuff with the orifices of the left pulmonary veins. Panel "B" is a 90 degree view of the donor cuff and pulmonary veins. Panel "C" shows the anastomosis (arrows); it is at this point that obstruction can occur if the donor lung does not sit properly, and the anastomosis undergoes torsion. I use colour-Doppler guided PW, or CW, so that I don't miss the point of obstruction.

In this case, colour-Doppler reveals velocity acceleration, and guides placement of the sample volume; the velocity is high. The obstruction to pulmonary venous drainage led to unilateral pulmonary edema; when the torsion of the anastomosis was relieved, (Figure-July answer 2), the velocity dropped and the patient improved.


Answer Image 1 - June 2011 - Tee of the Month
Answer Image '1'   (click to enlarge)


Answer Image Image 2 - July 2011 - Tee of the Month
Answer Image '2'   (click to enlarge)