Anesthesiology & Pain Medicine >> Education >> TEE of the Month

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


Coming later in 2016:

coming later in 2016

(click image to enlarge)



September 2016

September question: This CW Doppler indicates MR (jet 1). What are possible explanations of the other 2 jets?


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


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August 2016

August question: This patient comes to the OR with a diagnosis of TR secondary to a pacemaker lead "problem". Describe what you see, and see if there is an alternate explanation. Identify the structure with the question mark.

(Images courtesy of Dr. Andy Bowdle)


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

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


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

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


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

Video 5 - TEE of the Month
Video '5'   (click to enlarge)


August answer: As is seen in image 1 and video 5, there is a left to right shunt at the atrial level, which was not diagnosed prior to surgery. Also of note- right atrial and right ventricular enlargement, normal right and left ventricular function. There was significant central tricuspid regurgitation, but no other valvular lesions. So the question becomes is the right sided chamber enlargement the consequence of tricuspid regurgitation? Although it was thought that the pacemaker might have caused tricuspid valve incompetence, there was no indication of this on TEE. An alternative explanation is that a chronic left to right shunt may have caused right sided chamber enlargement, with secondary TR. The surgeon closed the septal defect and put a ring on the normally appearing tricuspid valve with a good result.

The ? indicates multiple reverberations of the pacing lead which is seen in video 1.


July 2016

July question: This patient was brought to the OR for LVAD placement, for severe LV dysfunction. (Video 1). One of the initial TEE images is seen in the 2nd video. What should you "advise" the surgeon to do?


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

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



July answer: This patient has a large mass in his left atrial appendage, which given the clinical circumstances, is most likely thrombus. The concern was that applying negative pressure to the LV would be transmitted to the LA, and might cause the thrombus to enter the VAD circuit, causing either obstruction or systemic embolization. After going on CPB, the Left atrium was opened and the clot material resected. The biggest portion is seen in the attached illustration. the LVAD was completed without incident.


Image - TEE of the Month
June Answer Image   (click to enlarge)