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




Aug 2015

August Question: This patient presented in cardiogenic shock after an MI. An Impella let ventricular assist device was placed, and he recovered nicely; when it was removed however, he went into pulmonary edema acutely. What was the reason?


Video 1 - TEE of the Month
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Video 1 - TEE of the Month
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July 2015

July Question: This patient was undergoing a mitral valve procedure for mitral valve prolapse. A mid esophageal inflow-outflow view was obtained showing significant TR. CW Doppler was performed and as seen in the image produced a dense jet with a peak gradient of 64 mmHg. The PA catheter (the position of which had been checked, and the catheter zeroed) yielded a pressure of 34/18 mmHg. What are possible explanations for this apparent discrepancy?


Image 1 - TEE of the Month
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Video 1 - TEE of the Month
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Video 1 - TEE of the Month
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July Answer: This patient was about to have a mitral procedure, and there was severe MR. When the color sector was increased in size to include the LA, it can be seen that the CW would have picked up the higher velocity MR jet (arrow) as well. In a general sense, misidentification of Doppler signals is a common error leading to inappropriate treatment. One reader mentioned the possibility in this case of a high velocity jet from the right coronary cusp to the RA.

The other explanation is that there was pulmonic stenosis or RVOT obstruction, in which case the estimated RVSP by TR jet would have been significantly greater than the PA pressure.


Answer Image 1 -  Tee of the Month
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May 2015

May Question: This patient presented to his local ER after 3 days of severe chest pain and SOB. Given his history, the EKG, and the 2 biplane TEEs from the trans-gastric position, what is the clinical scenario?

(Images courtesy of Burkhard Mackensen.)


Image 1 - TEE of the Month
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Video 1 - TEE of the Month
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Image 2 - TEE of the Month
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Video 2 - TEE of the Month
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Image 3 - TEE of the Month
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May Answer: As can be seen from the 3 graphics, the patient developed a pseudoaneurysm following an inferior septal MI, which ruptured into the RV creating a post infarct VSD. He was in profound cardiogenic shock; subsequently the VSD was closed percutaneously.

Answer Image 1 -  Tee of the Month
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Answer Image 2 -  Tee of the Month
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Answer Image 3 -  Tee of the Month
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April 2015

April Question: This patent had a procedure early in the day, and came in from home later that evening with light headedness and palpitations. What is the likely diagnosis? (Videos courtesy of Jorg Dziersk and Stefan Lombaard.)


Video 1 - TEE of the Month
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Video 2 - TEE of the Month
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April Answer: This patient had an ASD closure device placed, and returned from home when he began to experience light headedness and palpitations. The device was retrieved percutaneously, and a larger device was placed uneventfully.



March 2015

March Question: Looking at the 5 clips, can you put the likely clinical scenario together?


Video 1 - TEE of the Month
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Video 2 - TEE of the Month
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Video 3 - TEE of the Month
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Video 4 - TEE of the Month
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Video - TEE of the Month
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March Answer: The first 2 clips show the short and long axis view with a severe AR and what appears to be a flail left coronary cusp. From the history this was an acute on chronic situation although there was no evidence of endocarditis. The 5th video shows an enlarged and dysfunctional LV; secondary the patient developed functional MR (posteriorly directed) as seen in video 3. Video 4 shows a 3D image of the aortic and mitral valves and it is clear the mitral leaflets do no coat. The patient underwent AVR and mitral ring annuloplasty.



February 2015

February Question: What is indicated in the image? The video clip may offer a clue as to how the image was obtained.


Image 1 - TEE of the Month
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Video 1 - Jan TEE of the Month
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February Answer: 1=left upper pulmonary vein, 2=Warfarin ridge, 3=left atrial appendage. Judging by the movement of the appendage, the patient is in atrial fibrillation.



January 2015

January Question: This patient presents 8 years following an MVR with increasing SOB and evidence of hemolysis. What is the etiology of the 2 jets, and what are the therapeutic options, if any?


Image 1 - Jan TEE of the Month
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Video 1 - Jan TEE of the Month
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January Answer: The "A" jet is a posterior paravalvular jet, "B" a washing jet. Because this patient presented carrying an extremely high Perioperative risk, she was offered device closure which was successfully completed with near total resolution of the jet.

Answer Image 1 -  Tee of the Month
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