Anesthesiology & Pain Medicine >> Education >> TEE of the Month
Follow @donoxorn on Twitter
Follow me
@donoxorn

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 or iPads I recommend the following apps as excellent reference guides. The first is from the University of Toronto (same folks who brought you the Virtual TEE website) and the next 3 are from the American Society of Echocardiography


TEE Standard Views on Apple iPad App icon

iTunes Preview

Echo AUC App icon

American Society of Echocardiography
Echo AUC
iTunes Preview

ASA Pocket Guidelines App icon

American Society of Echocardiography
ASE Pocket Guidelines
iTunes Preview

iASE App icon

American Society of Echocardiography
iASE
iTunes Preview


Now available:

coming later in 2016

(click image to enlarge)

Book purchase allows the individual to utilize the Inkling platform on tablets and smart-phones to view full text and videos.



February 2019

February question: This patient had a calcified bio prosthetic aortic valve explanted and replaced with a Perceval©️valve. What is demonstrated by the deep trans gastric video and Doppler tracings?

Image 1 - TEE of the Month
Image'1'  (click to enlarge)

Video 1 - TEE of the Month
Video'1'  (click to enlarge)

Submit Your Answer Here

January 2019

January question: After you see the video, can you explain why there might be high RV systolic pressure, but much lower PA systolic pressure?

Image 1 - TEE of the Month
Image'1'  (click to enlarge)


January answer: This patient with pulmonary hypertension has an elevated PVR and subsequent right ventricular hypertrophy; the PVR is dramatically reduced with the lung transplant. The patient developed RVOT obstruction akin to lowering the SVR in someone with HOCM. The pulmonic valve is normal and the RV-PA gradient is solely due to the muscular sub valvular obstruction. Treated with fluids and the elimination of inotropic/chronotropic drugs.


December 2018

December question: This patient had P3 prolapse and severe MR as seen in the commissural view and the mitral reconstruction. After P3 resection and ring annuloplasty clips 3 and 4 are seen; what would you discuss with the surgeon?

Video 2 - TEE of the Month
Video'1'  (click to enlarge)

Video 1 - TEE of the Month
Video'2'  (click to enlarge)

Image 1 - TEE of the Month
Image '1'  (click to enlarge)

Video 3 - TEE of the Month
Video'3'  (click to enlarge)


December answer: Although the jet is small, it has a very bizarre direction; it is not from where the leaflets coapt. It would suggest that the repair stich had broken down.

The drawings show a normal P2 resection and the insert shows what a jet through a broken repair stich might look like.


Video 1 - TEE of the Month
Answer Video'1'   (click to enlarge)

November 2018

November question: After looking at the 4 videos, what is the most likely explanation for the MR, and why.

Video 1 - TEE of the Month
Video'1'  (click to enlarge)

Video 1 - TEE of the Month
Video'2'  (click to enlarge)

Video 2 - TEE of the Month
Video'3'  (click to enlarge)

Video 2 - TEE of the Month
Video'4'  (click to enlarge)



November answer: Although this patient with diffuse ASHD has global LV dysfunction the inferior wall is more profoundly depressed. Accompanying this is a restricted PML and posteriorly directed MR. This is Carpentier type 3A; abnormal mitral leaflet motion in systole caused by restriction of the PML due to leaflet tethering.


October 2018

October question: This 25 year old female had, 7 years prior to the current presentation undergone an ascending aortic replacement form the STJ just proximal to the innominate artery, and valvuloplasty of her bicuspid valve. 6 months prior to her current admission, she suffered a CVA -- her workup for PFO, MAC etc. was negative. There was no history compatible with AFib. The CVA resolved, and the TEE of the ascending aorta is shown. What are your thoughts?

Video 1 - TEE of the Month
Video'1'  (click to enlarge)



October answer: Interesting problem. It could not be a dissection as the ascending aorta had been replaced with graft material. It was thought that the neointima had peeled off the graft, and became a nidus for thrombus formation. The ascending aortic graft was replaced uneventfully.