Quiz 8 TEE - Dr. Kinkoff Flashcards
What is the element used to create the vibration in frequency and alternating electrical current?
Piezoelectric crystal
Ultrasound transmitted for the transducer into the patient interacts with the tissures in fours ways:
- Reflection
- Refraction
- Scattering
- Attenuation
Selecting the frequency of an ultrasound transducer is a trade off between:
- Image resolution
- depth of penetration
What is the usual frequency used in transesophageal echocardiography?
-3.5 - 7 million cycles per second (MHz)
________ echocardiography uses ultrasound scattered from blood cells to measure the velocity and direction of blood flow.
Doppler
What is the doppler effect?
- increases the frequency of waves scattered from cells moving toward the transducer
- Decreases the frequency of waves from cells moving away
What is the simplified version of Bernoulli equation?
P = 4V^2
P = Pressure gradient V = velocity
M-mode directs pulses of a _____, linear bean of ultrasound into the tissues and displays the distance from the transducer of the returning echoes on the ______ of ta graph with signal strength indicated by brightness. The ______ of the graph shows time and motion of the structures is seen as curved lines.
single
y axis
x axis
What is M-mode good for:
- precisely timing events within the cardiac cycle
- high temporal resolution (Lots of frames per second)
Two-dimensional echocardiography is made by very _______ moving the ultrasound beam through a plane creating ______ scan lines that are displayed simultaneously to construct a 2D tomographic image.
Rapidly
Multiple
How does two dimensional echocardiography accomplish its function?
-probes usually have phased array transducers which consist of 64 - 128 crystals
How many temporal resolution (frame rate) can a two dimensional echocardiography perform:
30 - 60 per second
Pulsed wave doppler measures the _____ and _______ of blood flow in a specific location called ___________, which can be placed by the user in the area of interest of a 2D image.
velocity
direction
sample volume
Velocities going toward the transducer are ____ the baseline of the y axis
above
Velocities going away from the transducer ____the baseline
below
What is the limitation of a pulse wave doppler?
-uses only one transducer to send and receive signals which limits the pulse repetition frequency which in turn limits the maximum doppler shift and blood velocity that can be measure with PWD.
What is the velocity limit of a Pulse Wave Doppler?
1.5 to 2 m/sec
Continuous Wave Doppler (CWD) measures the ______ and _______ of blood flow along the ____ of sight of the ultrasound beam.
velocity
direction
line
T/F: Continous Wave Doppler uses two transducers?
TRUE
T/F: Continous Wave Doppler have limit of the maximum velocity measures of 1.5 to 5 m/Sec.
FALSE (Has no limit)
What is another name for maximum doppler shift:
Nyquist limit
T/F: Continous Wave Doppler cannot determine the depth for the transducer from which a returning signal originated (range ambiguity) only its direction.
True
What conditions does a Continuous Wave Doppler good at measuring velocities?
- Aortic stenosis
- Mitral stenosis
Color Flow Doppler (CFD) is a form of ___ that ___________ the velocity information onto the simultaneously created 2D image of the heart, allowing the ______ and ________ of flow disturbances to be easily seen.
PWD
superimposes
location
timing
On a coloer flow doppler what does the color red mean?
flow toward the transucer
On a color flow doppler what does the color blue mean?
Flow going away from a transducer
Some color flow doppler have a variance map that show green; which signifies?
Turbulence (Mosiac)
What is the frame rate of a color flow doppler?
12 - 24 frames per second
What are the indication for a TEE in the ASA/SCA guidelines?
- All open hearts and thoracic aortic surgical procedures
- Considered in coronary artery bypass graft surgeries
What are the indications for a TEE in the ACC/AHA guidelines?
- vavle repair surgery
- valve replacement surgery with a stentless -xenograft,
- homograft or auto valve
- valve surrgery for infective endocarditis
How should a TEE probe insertion go?
-Gently (No FORCE should ever be used.
Transducer frequency is adjusted to the ______ frequency that provides adequate ______ of penetration to the structure being examined.
highest
depth
Image depth is adjusted to _____ the structure being examined in the display.
center
Overall image gain and dynamic range (compression) are adjusted so that the blood in the chambers appears nearly _____ and is distinct from the shades of ____ representing tissue.
black
gray
Time gain compensation controls are adjusted so that there is uniform brightness from the ____ field to the ___ field of the image.
near
far
Coloer Flow Doppler (CFD) gain is adjusted to a threshold that just _________ any background noise within the color sector.
eliminates
The ASE/SCA guidelines for performing a comprehensive intraoperative multiplane TEE examination are:
- 20 view
- All chambers
- All vavles
- Thoracic aorta
- Pulmonary Artery
Mid esophageal views are located where and consist of:
-TEE transducer posterior to the left atrium
(With multiplane TEE probe detailed examination of cardiac chambers and valves can be completed in most patients from this window alone)
TG view are located where and consist of:
- Transducer in stomach
- Image plane superior
- Images of the right and left ventricle can be seen
- Mitral valves
- Tricuspid Valves
Views to aligning the doppler beam parallel to flow through the left __________ outflow tract (LVOT) and aortic valve (AV) can be developed from the TG window.
ventricular
TG
Upper esophageal views are located where and consist of:
- transducer at the aortic arch level
- Can be seen in LAX and SAX
- Main pulmonary artery and pulmonary valve can be seen allowing alignment of the Doppler beam parallel to flow in these structures
Left ventricular is viewed at:
- ME two chamber
- ME four chamber
- ME LAX
- TG mid SAX
- TG two chamber views
Left ventricular size is viewed at what approach and what is the size suppose to be?
VIEWED -ME two chamber -TG two chamber Size: 5.4 cm for women < 6 cm for men
T/F: Left ventricular Gloval function may be assessed quantitatively or qualitatively.
TRUE
LV global function show ejection fraction(FRACTIONAL AREA CHANGE). What is the view approaches?
-TG mid SAX
THIS ONE IS IMPORTANT
What is the equation for obtaining the Fractional Area Change (FAC)?
FAC = (EDA - ESA)/EDA
Norma fractional Area Change (FAC) is:
> 50
Is Fractional Area Change correct when Wall motion abnormalities are present?
NO
Qualitative assessment of LV function is performed by considering all views of the LV and estimating the EF as:
- EEF > 55% = NORMAL
- EEF 45 to 54 % = mildly decreased
- EEF 35 to 44% = moderately decreased
- EEF 25 to 34% = moderately severly decreased
- EEF < 25% severly decreased
Assessment of regional LV function is divided into 17 region or segments. Each segment is rated qualitatively for thickining during systole using the following scale:
1 = (normal) 30% thickening 2 = (Mild hypokinesis) 10 - 30% thickening 3 = (Sever hypokinesis) <10% 4 = (Akinesis) no thickening 5 = (Dyskinesis) Thinning and paradoxical motion during systole
An increase in scale of _ or more in a regional LV function should be considered significant and suggestive of myocardial ischemia.
2
Impaired relaxation pattern with _______ peak E to A velocity ratio and _________ E wave deceleration time.
decreased
prolonged
Restrictive pattern with ________ peak E to A velocity ratio and decreased E wave deceleration time.
Increased
Decreased
Normal diastolic LV function corresponds with a:
- Positive inflow waves during systole (S wave)
- Positive inflow wave during diastole (D wave)
- Negative wave corresponding to atrial contraction ( A wave)
The mitral valve (MV) is viewed in:
-ME four chamber
-ME mitral commissural
-ME LAX
-TG basal SAX
(WITHOUT THE COLOR FLOW DOPPLER)
Prolapse of the MV is present when a portion of the leaflet moves to the _____ side of the annulus during _______.
Atrial
Systole
Flail is said to be present when a _______ ________ is ruptured and the corresponding segment of the valve leaflet is seen oscillating in the LA during systole.
chordae tendineae
T/F: Most patient have at least trace amounts of MR detected with TEE.
TRUE
Functional MR is due to d_______ of the MV annulus or __________ of the papillary muscles causing a decrease in the surface of coaptation of the MV leaflets.
- dilation
- displacement
T/F: Functional MR is very dynamic and can be affected by loading conditions.
TRUE
T/F: Myxomatous degeneration of the MV is a common cause of MR requiring surgery.
TRUE
Mitral Regurgitation of the prolapse and flail of the middle scallop of the posterior leaflet is the most common form and most ameanable to repair by resection of the involved portion and reinforcement of the annulus with an annuloplasty ring. What is another name for the middle scallop of the posterior leaflet?
P2
T/F: The most common causes of functional MR are reegional wall motion abnormalities (RWMAs) from coronary artery disease and generalized dilation of the right ventricle (RV).
FALSE (… of the Left Ventricle (LV)).
T/F: Rheumatic MR is caused by thickining and shortening of the MV leaflets and chordae restricting motion and closure during systole, usually requiring presthtic valve replacement.
TRUE
Proximal isovelocity surface area (PISA) is a method to quantify MR with echocardiography using ___ and ___.
CFD
CWD
Proximal isovelocity surface area (PISA) is most commonly applied to ______ MR and is probably not as accurate for ________ MR
central
eccentic
T/F: If the regurgitant orifice area is less then 0.4 cm^2 then it is mid regurgitation.
FALSE (0.2 cm^2)
T/F: if the regurgitant oriface area is greater than 0.4 cm^2 then is is sever MR.
TRUE
Gauge of mitral stenosis is the area being < 1 cm^2 is considered:
Severe
Gauge of mitral stenosis is the area being 1 to 1.5 cm^2 is considered:
Moderate
Mitral Stenosis planimetry can be viewed from:
TG basal SAX
In proximal isovelocity surface area (PISA) during MR when velocity reaches the limit of the CFD scale, aliasing of the signal occurs and the color mapped onto the 2D image changes from red to blue on the ventricular side of the valve.
During MS the coloring goes from blue to red.
T/F: The distal ascending aorta and proximal aortic arch may be obscured by the trachea.
TRUE
What type of diseases may be detected with a TEE:
- Atherosclerosis
- Aneurysm
- Dissection
Aorta dissection are categorized into two sections:
Section A: Requiring immediate surgery and the ascending aorta
Section B: Does NOT involve the ascending aorta and usually are treated without surgery
Residual regurgitation of a repaired mitral valve of a 1 (mild) is probably acceptable.
Yes
Residual regurgitation of a repaired mitral valve of a 2 moderate should lead to consideration of revision of the repair or valve replaement.
Yes
T/F: For a ventricular assist device to work the outflow leaflet must be reasonably competent.
TRUE
The transmission of sound through tissue is about:
1540 m/s
What are the two methods for producing a 3D image?
- off line computed rendering of a series of 2D images acquired separately within a short period of time
- Realtime insonation of a volume of tissue
