Features
www.uwanesthesiology.org/echoTransesophageal 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 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.
March 2010
March Question: This patient, who had heart surgery 12 years ago, presents with increasing shortness of breath, especially when recumbent. All of these clips were taken at the same depth in the esophagus. What structures are identified by the letters, and what is the most likely clinical scenario.
February 2010
February Question: This 32 year old previously healthy, pregnant (20 weeks) individual presented with a 3 hour history of substernal chest pain, and several TEE images are presented. Put them all together.
(Images courtesy of Jorg Dziersk, MD)
February Answer: This patient had an aortic valve replacement and the pathologic diagnosis was a papillary fibroelastoma. It was theorized that part of it had embolized down the left coronary artery occluding the LAD; this was confirmed at cardiac cath.
A papillary fibroelastoma is a benign cardiac tumor that typically occurs on the aortic or mitral valve. Unlike valvular vegetations, these tumors tend to be located on the downstream (instead of upstream) side of the valve and are not associated with destruction of the underlying valve disease. The macroscopic appearance of these tumors is a frond-like mass, sometimes with superimposed thrombus. Microscopically, there is abundant elastic and fibrous tissue—similar to the normal component of the valve leaflet. The prevalence of papillary fibroelastomas increases with age, although the gender distribution is about equal. The most common valve sites (in order of prevalence) are aortic (44%), mitral (35%), tricuspid (13%) and pulmonic (8%) valves, with size at the time of detection ranging from 2 to 70 mm.
Reference: Gowda RM, Khan IA, Nair CK et al. Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases. Am Heart J 2003; 146:404–10
January 2010
January Question: This patient had previously undergone aortic valve replacement for chronic AR, but developed progressive LV dilation and reduced systolic function. He now presents for LVAD placement.
1) What do the images of the mitral valve show?
2) What procedure would have to be done in conjunction with the LVAD placement?
January Answer: This patient had a dilated cardiomyopathy secondary to aortic valve disease, and presented for LVAD placement. The perturbation in his LV geometry led to extreme tethering of his posterior mitral leaflet, with abnormal coaptation and MR. Because his AV prosthesis was mechanical, it was explanted and replaced with a tissue prosthesis; because the AV opening after LVAD placement is minimal, there is an increased risk of thrombosis and embolization.
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