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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 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
American Society of Echocardiography
Echo AUC
iTunes Preview
American Society of Echocardiography
ASE Pocket Guidelines
iTunes Preview
American Society of Echocardiography
iASE
iTunes Preview
April 2014
April Question: At surgery for a type "A" dissection, the surgeon asks you to examine the descending aorta, and you come upon this image. What is indicated by the arrow?
March 2014
March Question: What's wrong with this picture?
March answer: The 2 videos and 1 still explain the situation. The 2D RV inflow-outflow and the midesophageal long axis are missing the aortic valve! In fact this patient had previously had a prosthetic valve placed, which subsequently became infected. At reoperation, the annulus was so destroyed that the surgeon had to place the new prosthesis in a supra-annular position. Several years later a cath was performed because of progressive chest pain. The valve (red arrow) is seated just below the obstructed LMCA (white arrow).
February 2014
February Question: What device is illustrated? (In some views, the A-V valve seen does not appear to be opening properly; ignore this; it is just the way the valve is cut; in fact it opens normally). Images courtesy of Peter Von Homeyer.
February answer: This is a double lumen cannula placed for V-V ECMO for respiratory failure. The attached image shows the anatomic relationships. This view was obtained from the transgastric view of the RV in long axis. Deoxxygenated blood is drained from the IVC and SVC to the device, and returned via another lumen to the RA; it is essential that this lumen faces the tricuspid so that blood leaving the device enters the RV and does not recirculate in RA.
January 2014
January Question: In this patient with a history of a myocardial infarction, which coronary artery is most likely affected? Assuming there is no other major coronary disease, is the circulation right or left dominant? (Video clips 1,2,3) What about in the patient represented in video clip 4?
January answer: In first 3 clips, there is evidence of a basal inferior and posterior wall infarction. This implies RCA involvement with a right dominant circulation. The dominance means that the PDA or posterior descending artery, which supplies the posterior wall, originates from the RCA. In the last video clip the anterior, lateral and posterior walls are affected; this means that the left main coronary is affected and the circulation is left dominant, that is, the PDA comes off the circumflex. See image.
