TEE / 3D

Question 1

P1 scallop position

Answer 1

Anterolateral near LAA

Question 2

P2 scallop position

Answer 2

Middle

Question 3

P3 scallop position

Answer 3

Medial

Adjacent to atrial sept`um

Question 4

Mitral scallops mid-esoph 0’ 4 chamber

Answer 4

A2-P2

Question 5

MV scallops above mid-esoph (see AV)

Answer 5

A1-P1

Question 6

MV scallops mid-esoph, push probe down

Answer 6

A3-P3

Question 7

MV scallops commissural view (mid-E 30-90)

Answer 7

P1-A2-P3

Question 8

MV scallops long axis (135’)

Answer 8

A1-P1

Question 9

Eustachian Valve

Answer 9

Membrane like structure near IVC or SVC

Question 10

Chiari Network

Answer 10

Remnant of right hear valve of sinus venosus

Highly mobile mass in RA

Question 11

Crista terminalis

Answer 11

Pillar that separates smooth from trabeculated part of right atrium

Question 12

3DE Artifacts

Answer 12

Drop out
Blooming
Railroad
Reverberation

Question 13

3D quality determined by

Answer 13

2D quality
Avoiding motion
EKG and respiratory gating

Question 14

Fully sampled matrix array transducers # of piezoelectric elements

Answer 14

3000

Question 15

Multibeat acquisition improves

Answer 15

Temporal resolution

Volume rate

Question 16

Increasing volume rate

Answer 16

Multibeat acqusition
Decreasing imaging depth
Decreasing sector width
Using zoom

Question 17

3D vs 2D for LV volumes

Answer 17

3D better accuracy and reproducibility

Question 18

3D improve estimation of volumes

Answer 18

Increased depth
Narrow sector sizes
Multibeat acquisition

Question 19

Lowest variability method for LA size

Answer 19

3D echo

Question 20

Method for RV volumes with 3D

Answer 20

Method of discs

Question 21

Limitations of 3D doppler

Answer 21

Low temporal and spatial resolution

Question 22

Best method for MV stenosis after balloon

Answer 22

3D planimetry

Question 23

Standard surgeon’s view of MV

Answer 23

AV at 11-12:00
LAA at 9:00
Posterior valve centered at 6:00
Interatrial septum between 2 and 3:00

Question 24

TEE sensitivity for aortic dissection

Answer 24

> 95%

Question 25

Midesophageal view most anterior AV cusp

Answer 25

Right

Question 26

Midesophageal view non-coronary cusp

Answer 26

Adjacent to interatrial septum

Question 27

TEE view for A-P guidance for transeptal puncture

Answer 27

Short axis at level of aortic valve

Question 28

Longest radial length tricuspid leaflet

Answer 28

Anterior

Question 29

Shortest radial length tricuspid leaflet

Answer 29

Septal

Question 30

TEE view for AV gradients

Answer 30

Deep trans gastric view at 0 degrees with anteflexion

Question 31

Ddx for AV endocarditis

Answer 31

Lambl's excrescences Thickened arantius nodules Fibroelastomas

Question 32

Lambl's excrescence

Answer 32

Filamentous structures attached to ventricular side of AV

Question 33

Arantius nodules

Answer 33

Present at center of free margin of each of the AV cusps

Question 34

Fibroelastomas

Answer 34

Benign tumors attached to aortic side of AV

Question 35

Methemoglobinemia characteristics

Answer 35

Cyanosis Low oxygen sat Normal arterial PO2

Question 36

Treatment for methemoglobinemia

Answer 36

IV methylene blue

Question 37

Absolute contraindications to TEE

Answer 37

Esophageal or pharyngeal obstruction Esophageal diverticulum Active GI bleeding Perforated viscus

Question 38

Relative contraindications to TEE

Answer 38

Esophageal varices History of radiation to the neck Barrett esophagus Coagulopathy

Question 39

Flail mitral valve leaflet

Answer 39

Ruptured chord visualized | Tip of leaflet points superiorly into left atrium in systole

Question 40

Fibroelastoma characteristics

Answer 40

Round or oval, irregular, well demarcated borders Most <20mm Half have mobile stalks, are mobile

Question 41

Myxoma

Answer 41

Most common benign tumor Attached by stalk to interatrial septum Surgery indicated

Question 42

MV ring dehiscence TEE

Answer 42

Suspect when portion of ring floating in middle of mitral annular orifice Associated MR

Question 43

Causes of dilated coronary sinus

Answer 43

RA hypertension due to right sided failure, TR, pHTN Persistent left SVC draining into CS Anomalous PV drainage into CS

Question 44

Confirmation of left SVC to CS

Answer 44

Bubbles injected into left arm appear in CS prior to RA