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.
American Society of Echocardiography
ASE Pocket Guidelines
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 Question: What structure in indicated by the arrow ? (Image courtesy of Dr. Andy Bowdle)
December Answer: Although somewhat ambiguous, most would describe the structure as the Eustachian Valve, or valve of the inferior vena cava. Its purpose in embryo is to direct oxygenated blood from the placenta and via the IVC, towards the foramen ovalve, where it gains entrance to the left atrium. The Chiari network is a filamentous right atrial structure which is also an embryonic remnant and has no known purpose in adult life.
November Question: Video clips and stills are presented from a patient who presented for surgery.
November Answer: This patient had a connective tissue disorder, specifically Marfan's syndrome. As seen in the. video clips there is only mild AR , with normally appearing leaflets. The stills show a grossly enlarged aortic root with tapering in the ascending aorta. The decision was made to excise the aorta that was dilated including the sinuses, reimplant the coronaries, and, resuspend the native aortic valve leaflets inside a Dacron graft. This is the so called "David Procedure" named for Dr. Tirone David of Toronto. As seen in the post procedure videos, the leaflets coapt nicely and there is no AR.
October Question: what is seen in the 2 videos and the 2 stills from this 40-year-old patient with increasing dyspnea on exertion?
October Answer: This 18 year old woman underwent a balloon valvuloplasty of her pulmonic valve at 4 months of age. She subsequently developed pulmonic regurgitation, and presented for valve replacement.
Videos 1 and 2 show the pulmonic valve from a high esophageal position. The leaflets are thickened with rolled up edges. A jet of pulmonic regurgitation is seen. The first still image demonstrates a steep deceleration slope, and the second still image shows a vena contracta of 0.7 cm, both indicative of severe PR. A tissue prosthesis was placed, and the patient made an uneventful recovery.
September Question: 1) What is the diagnosis? 2) What are some of the classic echo stigmata seen in the 3 video clips? 3) What is the finding in the still and what would lead to inaccuracy in its interpretation? 4) The patient complains of a hoarse voice—how might that be related to the findings in the TEE?
September Answer: this patient demonstrates the echocardiographic findings of rheumatic mitral stenosis, as illustrated in the image:
August Question: this patient had a Bentall procedure 3 days prior, and now has the following TEE; what is the diagnosis and presumptive aetiology? What is the structure(s)indicated by the arrow in the still frame?
Images courtesy of Dr. Efthimios Anagnostou, Thessaloniki, Greece.
August Answer: The diagnosis is a dehiscence of the graft from the area of the aorto-mitral curtain. There does not appear to significant aortic regurgitation. As it is so early on in the postop course, infection is less likely the aetiology, and it is probably related to suture dehiscence. The structure indicated by the arrow is the bifurcation of the left main coronary artery into the circumflex and the LAD. (See image '2'.)
July Question: In this video and image, what is the structure (α) and what is the color Doppler signal (β)?
July Answer: This is a transgastric view with the probe turned to the patient's right. The images demonstrate a massive right coronary sinus of Valsalva aneurysm, which is protruding into the right ventricular outflow tract, causing acceleration of flow. The aneurysm is unruptured, and demonstrates spontaneous contrast but no thrombus.
The color signal indicated by beta is a mirror image artifact; in fact the signal is outside the heart! The attached image (July_answer.) shows how the pericardial surface acts as a strong reflector. The white arrow is the path the Doppler takes as it is reflected, but the ultrasound machine "thinks" it is following the red arrow, so that the signal also appears in the mirrored location.