Anesthesiology & Pain Medicine >> Education >> TEE of the Month >> 2002 July – December

Transesophageal Echocardiogram of July-Dec 2002

TEE pictures furnished by Dr. Donald Oxorn, UW Anesthesiologist

December 2002 TEE

December 2002
Question: What is the nature of the malfunction of this St. Jude's mitral prosthesis, seen on TEE immediately after separation from cardiopulmonary bypass?

Answer: This patient had bi-leaflet mitral valve prolapse (MVP), and had replacement with a St. Jude's bileaflet mechanical prosthesis. Surgeons try to preserve as much of the native apparatus as possible in order to minimize the effects on LV function. In this instance, residual tissue interfered with valve closure resulting in a large unilateral regurgitant jet; on the other side, the normal "cleaning jet" is seen. This redundant tissue was resected, and the jet disappeared.


November 2002 TEE

November 2002
Question: This 28 year old female presents with a history of increasing dyspnea on exertion. What is evident from these transgastric views of her LVOT and aortic valve? (You must enlarge the animation to answer this question).

Answer: The patient was a young woman with increasing exertional dyspnea, who was found on TTE to have a subaortic membrane. The Intraoperative TEE shown was obtained from the transgastric position at 81 degrees, and shows both the membrane and the aliasing of colour flow as it accelerates through the subaortic narrowing. A supplemental intraoperative Doppler revealed a significant gradient. When obtaining aortic gradients from the transgastric position, the operator must be parallel to outflow; I am the most confident when I can visualize the LVOT, aortic valve, and ascending aorta, and am parallel to all three with the Doppler beam.

October 2002 TEE

October 2002
Question: This 19 year old female presents with symptoms of right heart failure- What is the pathologic process involved?

Answer: This patient has muscular stenosis of the RVOT, with flow acceleration through the narrowing. RVH is also evident. A gradient of close to 100 mmHg was measured from a transgastric long axis view. This is a TEE image; because it closely resembles a transthoracic parasternal long axis, a number of people mistakenly identified this image as showing mitral insufficiency. A myomectomy was performed through the anterior wall of the RVOT with a satisfactory diminution of the gradient

September 2002 TEE

September 2002
Question: This patient presented for aortic root aneurysm repair, having previously had an aortic valve replacement. Judging by the systolic color flow pattern, what type of prosthetic aortic valve had been inserted?

Answer: Starr-Edwards Valve (ball-cage)

August 2002 TEE

August 2002
Question: This 68 year old man presents in pulmonary edema and cardiogenic shock. What is the diagnosis?

Answer: Rocking prosthetic aortic valve, with aortic root abscess, aorto-left atrial fistula.

July 2002
Question: The RV seems to be contracting, but the Aortic Valve is not opening! What is the clinical scenario?

Answer: Left ventricular assist device in place