Utah TEE Basic Exam

Question 1

When you are in the midesophageal AV Short Axis view, what should you do to better interrogate the valve (5 things)

Answer 1

1. Advance/withdraw to see coaptation
2. Multiplane for symmetrical cusps
3. Check bi/tri-leaflet
4. Normal excursion and coaptation
5. Sclerocalcific changes

Question 2

How much do you add on the multiplane from the AV Midesophageal Short Axis to get to the ME AV LAX view?

Answer 2

Add ~90° to multiplane for next view

Question 3

What is your goal when viewing the Midesophageal AV Short Axis?

Answer 3

Rule out AS

Evaluatae Structurla Abnormalities of the AV Valve

Question 4

When you are in the ME AV SAX view and you withdraw probe what should you see?

Answer 4

Withdraw probe for coronary ostia

Question 5

When you are in the ME AV SAX view and you advance probe what should you see?

Answer 5

LVOT

Question 6

Identify every structure in the ME AV SAX view:

LA

IAS

RA

LA

Coronary Ostia

Answer 6

In the ME AV SAX view (30-45°) the image plane is directed thru the LA and aligned parallel to the AV annulus.

All three aortic cusps should appear symmetrical.

The non-coronary cusp of the aortic valve is adjacent to the inter atrial septum

The right coronary cusp is most anterior

The left coronary cusp is adjacent to the pulmonary artery.

Question 7

What are 4 pathology you can look for in the midesophageal AV SAX?

Answer 7

1. Aortic Valve disease
2. Atrial septal defect (ASD) (secundum)
3. LA size
4. Coronary artery pathology

Question 8

What are you looking at specifically in the ME AV Long Axis view?

Answer 8

1. Check for normal coaptation
2. Degree of Calcification
3. Normal Aortic Size

Question 9

What are your 4 goals when evaluating the Midesophageal AV Long Axis?

Answer 9

1. Rule out AS
2. Rule out AI
3. Identify Type A Dissections
4. See a dynamic LVOT Obstruction

Question 10

When you rotate Right and Left in the ME AV Long Axis view, what are you doing?

Answer 10

Rotate R/L until leaflet excursion is clear & central, sinuses symmetric

Question 11

What leaflets are seen in of the mitral valve on the ME Aortic Valve LAX View?

Answer 11

Anterior (AMVL) + Posterior (PMVL) Leaflets

Question 12

Label a, b, c, d

Answer 12

aortic annulus (a)

sinus of Valsalva (b)

sinotubular junction (c)

proximal ascending aorta (d)

Question 13

What is a normal Aortic Annulus Size?

Answer 13

1.8-2.3 cm (18 - 23 mm)

Question 14

What aortic valve coronary cusps are seen on the ME Aortic Valve LAX View?

Answer 14

Right coronary cusps is at the bottom of image (Anterior structures are more towards the bottom of the image)

NCC or LCC are at the superior aspect of the image (These are posterior structures)