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




December 2015

December Question: This 30 year old patient had atrio-ventricular canal defect repaired as a child, and now presents with MR, and recurrence of the ASD. TEE is as shown; identify the structures 1,2 and 3. (Note: Watch the videos in their entirety.)

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

Image 2 - TEE of the Month
Image'2'   (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)



December answer: 1 is the left upper pulmonary vein, 3 is the left atrial appendage, and 2 is a persistent left SVC, which is usually seen in this position, and fills with echo bubbles after an injection in a left sided IV.



November 2015

November Question: This 78 year old male was scheduled for TAVR.

Video 1 is an xplane of the aortic valve.

Video 2 is a 3D view of the valve.

Image 1 is a 3D Reconstruction of the LVOT with measurements seen, which can be compared to the measurements made on CT:

Annular dimensions at LVOT = 32 x 28 mm
Annular area at LVOT = 663 mm2

Video 3 shows the initial deployment of the valve.

In video 4 and image 1, the arrows indicate a new finding after valve deployment.

In video 5, a midesophageal long axis view is obtained.

The patient is hemodynamically stable. What should you tell the interventionalist?


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

Image 2 - TEE of the Month
Image'2'   (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)


November answer: This patient had a TAVR in which the CT measurements and the 3DTEE measurements of the aortic annulus were discrepant. The valve was sized to the larger measurements. The result was sub annular rupture with periaortic hematoma seen on videos 3 and 5, and a new pericardial effusion seen on image 2 and video 4. The patient had a sternotomy, explanation of the TAVR, oversewing of the subannular defect, and placement of a standard pericardial aortic tissue valve.



September 2015

September Question: Which portion of which leaflet is involved in this patient's MR? What does the arrow indicate?


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

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


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

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



September answer: Although the first video shows what appears to be unequivocal P3 prolapse, the first image, a midesophageal 4 chamber view, shows a posteriorly directed jet which implies anterior leaflet involvement; the putative segment can be seen close to A2. A 3D TEE is conclusive.


Answer Image 1 -  Tee of the Month
September Answer Image (click to enlarge)


August 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
Video '1'   (click to enlarge)

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



August Answer: Because of a recent myocardial infarct and decreased systolic function, an Impella was placed (see Anesthesia & Analgesia. 114(1):82-85, January 2012 for description of the device). Upon removal, the patient developed acute pulmonary edema, and TEE showed severe AR. This 3D TEE with the ROVT in the foreground showed probable injury to the non coronary cusp, which was managed with an emergency TAVR.