ECHO - TEE Flashcards

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1
Q

What LAA emptying velocities are associated with stroke in patients with A-Fib?

A

< 20 cm / s

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2
Q

What are low LAA emptying velocities (< 20 cm/s) associations?

A
  • severe spontaneous echocardiographic contrast
    • poor prognosis with increased mortality
  • appendage thrombus
  • cardioembolic events
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3
Q

What is the sensitivity of TEE for acute ascending aortic dissection?

A

> 95% sensitivity

  • also highly specific
  • intimal flaps are easily visualized when present in the proximal ascending aorta, distal arch and descending thoracic aorta
  • sensitivity and specificity verified with comparison to CTA and MRA
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4
Q

In the mid-esophageal TEE short axis view of the aortic valve, which cusp is:

  • adjacent to the interatrial septum
  • most anteriorly located

***in normal trileaflet valves

A
  • adjacent to interatrial septum –> non-coronary
  • most anteriorly located –> right coronary
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5
Q

What view is best to aid in TEE guided transseptal puncture (either anteriorly or posteriorly)?

A

Short-axis view at the level of the aortic valve (at the level of the aortic root)

  • correct placement of the needle for transseptal puncture is paramount for the safety of the procedure
  • to avoid aortic puncture, the needle has to be manipulated posteriorly to the aorta
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6
Q

What are the appropriate techniques for probe insertion?

  • Control wheels
  • Examination of probe
  • Patient position
  • Neck position
A
  • Control wheels –> unlocked
    • knobs should never be locked to diminish the possibility of pharyngeal or esophageal injury
  • Examination of probe –> inspected for damage before insertion and a live sector image should be on the screen
    • helps to confirm normal probe function
  • Patient position –> left lateral decubitus position
  • Neck position –> anterior flexion of the neck
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7
Q

What are the TV leaflets and radial length size?

A
  • Anterior –> longest radial length
  • Septal –> shortest radial length
  • Posterior

**Ratio anterior-septal-posterior –> 1 : 1 : 0.75

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8
Q

What is the longest and most apically positioned cardiac valve?

A

Tricuspid valve

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9
Q

What views are utilized in assessment of the TV?

A
  • ME4C
    • septal and anterior leaflets are typically visible
  • ME inflow-outflow view
  • ME modified bicaval TV view
    • may be the most useful for color flow Doppler and spectral Doppler
  • TG RV basal view
  • TG RV inflow-outflow view
  • TG RV inflow view
    • TG views allow posterior leaflet to be seen in near field
  • TG (deep) LAX views (0 degrees)
    • maximal anteflexion +/- rigth flexion
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10
Q

Why is it difficult to visualize TR jets on TEE?

What can be done to improve visualization?

A
  • Regurgitant jets are typically not coaxial with the US beam
  • Explore in other angles
    • 70-100 degree views are often best for continuous wave Doppler interrogation
    • 150 degree view (in patients with normal sized aorta) –> TR jet size assessment
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11
Q

What is the best TEE view for assessing aortic valvular gradients?

A

Deep TG view at 0 degrees with anteflexion

  • objective is alignment of the aortic valve and proximal ascending aorta as prallel as possible witht he continuous wave Doppler cursor
  • 90-100 degrees –> probe slowly pulled back keeping the aneflexion and the tip adjusted with the lateral knob
  • also important in patients with HOCM
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12
Q

What is the significance of spontaneous echo contrast (smoke) in the LAA?

A

highly associated with previous stroke or peripheral embolism in patients with A-fib

  • increased risk of thromboembolic events
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13
Q

Why is it important to anticoagulate patients when cardioverted in A-fib?

A

increased thromboembolic risk

  • DCCV –> LAA stunning with increased severity of echocontrast immedately after the procedure
  • case reports of patients, not anticoagulated, with no LAA thrombus on pre-cardioversion TEE who develop stroke after cardioversion
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14
Q

What is the differential diagnosis for suspected aortic valve endocarditis?

A
  • Lambl’s excresence
    • filamentous structures attached to the ventricular side of the valve
  • Arantius nodules
    • present in the center of the free margin of each of the three cusps of the aortic valve
  • Fibroelastomas
    • benign tumors often attached to the aortic side of the valve
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15
Q

What are the absolute contraindications to TEE?

A
  • Perforated viscus
  • Esophageal
    • stricture
    • tumor
    • perforation, laceration
    • diverticulum
  • Upper GI bleed (active)
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