NBE Transesophageal Echocardiography 2 — Questions and Answers
Question 1: Which TEE view best demonstrates the left atrial appendage (LAA) for thrombus detection?
- Midesophageal four-chamber view
- Midesophageal two-chamber view (Correct answer)
- Transgastric short-axis view
- Upper esophageal aortic arch view
Correct answer: Midesophageal two-chamber view
The midesophageal two-chamber view at 90° provides the best visualization of the LAA for thrombus detection.
Question 2: During TEE, spontaneous echo contrast ('smoke') in the left atrium is associated with:
- Increased cardiac output
- Low flow states and increased thromboembolic risk (Correct answer)
- Mitral valve prolapse
- Aortic stenosis
Correct answer: Low flow states and increased thromboembolic risk
Spontaneous echo contrast reflects erythrocyte aggregation under low-shear flow conditions, indicating increased stasis and thromboembolic risk.
Question 3: What is the normal emptying velocity of the left atrial appendage on pulsed-wave Doppler during TEE?
- Less than 10 cm/s
- Greater than 40 cm/s (Correct answer)
- 10–20 cm/s
- 20–30 cm/s
Correct answer: Greater than 40 cm/s
Normal LAA emptying velocity is greater than 40 cm/s; values below 20 cm/s indicate significant stasis.
Question 4: In TEE, the coronary sinus is best visualized in which view?
- Midesophageal four-chamber view (Correct answer)
- Transgastric two-chamber view
- Midesophageal long-axis view
- Upper esophageal bicaval view
Correct answer: Midesophageal four-chamber view
The coronary sinus appears as a circular structure at the posterior atrioventricular groove in the midesophageal four-chamber view.
Question 5: Which artifact is most commonly encountered when imaging the ascending aorta with TEE due to the interposition of the trachea?
- Side lobe artifact
- Mirror image artifact
- Reverberation artifact
- Blind spot artifact (Correct answer)
Correct answer: Blind spot artifact
The trachea and left main bronchus create a 'blind spot' in the ascending aorta, limiting TEE visualization of this segment.
Question 6: Which TEE finding is most consistent with severe mitral regurgitation?
- Vena contracta width < 3 mm
- Pulmonary vein systolic flow reversal (Correct answer)
- E/A ratio < 1
- Mitral valve area > 2.0 cm²
Correct answer: Pulmonary vein systolic flow reversal
Pulmonary vein systolic flow reversal on TEE Doppler is a hallmark of severe mitral regurgitation.
Question 7: The descending thoracic aorta is best assessed with TEE by:
- Advancing the probe to the transgastric position
- Rotating the probe 180° posteriorly from standard positions (Correct answer)
- Rotating the transducer to 0° and withdrawing slowly
- Using the upper esophageal window at 90°
Correct answer: Rotating the probe 180° posteriorly from standard positions
Rotating the probe 180° (leftward) from standard positions brings the descending thoracic aorta into view along the posterior spine.
NBE Transesophageal Echocardiography 2
Which TEE view best demonstrates the left atrial appendage (LAA) for thrombus detection?