TEE / 3D Flashcards
P1 scallop position
Anterolateral near LAA
P2 scallop position
Middle
P3 scallop position
Medial
Adjacent to atrial sept`um
Mitral scallops mid-esoph 0’ 4 chamber
A2-P2
MV scallops above mid-esoph (see AV)
A1-P1
MV scallops mid-esoph, push probe down
A3-P3
MV scallops commissural view (mid-E 30-90)
P1-A2-P3
MV scallops long axis (135’)
A1-P1
Eustachian Valve
Membrane like structure near IVC or SVC
Chiari Network
Remnant of right hear valve of sinus venosus
Highly mobile mass in RA
Crista terminalis
Pillar that separates smooth from trabeculated part of right atrium
3DE Artifacts
Drop out
Blooming
Railroad
Reverberation
3D quality determined by
2D quality
Avoiding motion
EKG and respiratory gating
Fully sampled matrix array transducers # of piezoelectric elements
3000
Multibeat acquisition improves
Temporal resolution
Volume rate
Increasing volume rate
Multibeat acqusition
Decreasing imaging depth
Decreasing sector width
Using zoom
3D vs 2D for LV volumes
3D better accuracy and reproducibility
3D improve estimation of volumes
Increased depth
Narrow sector sizes
Multibeat acquisition
Lowest variability method for LA size
3D echo
Method for RV volumes with 3D
Method of discs
Limitations of 3D doppler
Low temporal and spatial resolution
Best method for MV stenosis after balloon
3D planimetry
Standard surgeon’s view of MV
AV at 11-12:00
LAA at 9:00
Posterior valve centered at 6:00
Interatrial septum between 2 and 3:00
TEE sensitivity for aortic dissection
> 95%
Midesophageal view most anterior AV cusp
Right
Midesophageal view non-coronary cusp
Adjacent to interatrial septum
TEE view for A-P guidance for transeptal puncture
Short axis at level of aortic valve
Longest radial length tricuspid leaflet
Anterior
Shortest radial length tricuspid leaflet
Septal
TEE view for AV gradients
Deep trans gastric view at 0 degrees with anteflexion
Ddx for AV endocarditis
Lambl’s excrescences
Thickened arantius nodules
Fibroelastomas
Lambl’s excrescence
Filamentous structures attached to ventricular side of AV
Arantius nodules
Present at center of free margin of each of the AV cusps
Fibroelastomas
Benign tumors attached to aortic side of AV
Methemoglobinemia characteristics
Cyanosis
Low oxygen sat
Normal arterial PO2
Treatment for methemoglobinemia
IV methylene blue
Absolute contraindications to TEE
Esophageal or pharyngeal obstruction
Esophageal diverticulum
Active GI bleeding
Perforated viscus
Relative contraindications to TEE
Esophageal varices
History of radiation to the neck
Barrett esophagus
Coagulopathy
Flail mitral valve leaflet
Ruptured chord visualized
Tip of leaflet points superiorly into left atrium in systole
Fibroelastoma characteristics
Round or oval, irregular, well demarcated borders
Most <20mm
Half have mobile stalks, are mobile
Myxoma
Most common benign tumor
Attached by stalk to interatrial septum
Surgery indicated
MV ring dehiscence TEE
Suspect when portion of ring floating in middle of mitral annular orifice
Associated MR
Causes of dilated coronary sinus
RA hypertension due to right sided failure, TR, pHTN
Persistent left SVC draining into CS
Anomalous PV drainage into CS
Confirmation of left SVC to CS
Bubbles injected into left arm appear in CS prior to RA
