NBE Transesophageal Echocardiography 3 — Questions and Answers
Question 1: On TEE, a patent foramen ovale (PFO) is confirmed by:
- Color Doppler showing left-to-right shunting at rest
- Agitated saline contrast crossing from right to left atrium within 3 cardiac cycles (Correct answer)
- Tissue Doppler showing abnormal septal velocities
- Mitral inflow E/A reversal
Correct answer: Agitated saline contrast crossing from right to left atrium within 3 cardiac cycles
Bubble contrast crossing from right to left within 3 cardiac cycles (especially with Valsalva release) confirms a PFO on TEE.
Question 2: Which structure is located at the superior aspect of the interatrial septum and can be mistaken for a pathologic mass on TEE?
- Chiari network
- Eustachian valve
- Crista terminalis
- Limbus of the fossa ovalis (Correct answer)
Correct answer: Limbus of the fossa ovalis
The limbus of the fossa ovalis is a normal thickened ridge at the superior interatrial septum that can appear mass-like on TEE.
Question 3: TEE is preferred over TTE for evaluation of prosthetic mitral valve regurgitation primarily because:
- TEE offers higher temporal resolution
- Acoustic shadowing from the prosthesis obscures regurgitant jets on TTE (Correct answer)
- TEE has lower frequency transducers that penetrate better
- Prosthetic valves are only visible with TEE
Correct answer: Acoustic shadowing from the prosthesis obscures regurgitant jets on TTE
Prosthetic valve material causes acoustic shadowing that masks regurgitant jets on transthoracic imaging, while TEE views from behind avoid this artifact.
Question 4: In the context of TEE during cardiac surgery, which finding best indicates adequate de-airing of the left ventricle before coming off cardiopulmonary bypass?
- Absence of aortic regurgitation
- No microbubbles visible in the left ventricular cavity (Correct answer)
- Normal LV wall motion in all segments
- Mitral valve leaflets coaptating normally
Correct answer: No microbubbles visible in the left ventricular cavity
Resolution of microbubbles within the LV cavity on TEE confirms adequate de-airing before weaning from bypass.
Question 5: Which TEE view is used to measure the aortic valve annulus diameter for TAVR planning?
- Transgastric long-axis view
- Midesophageal aortic valve long-axis view at 120–135° (Correct answer)
- Upper esophageal aortic arch short-axis
- Midesophageal four-chamber view
Correct answer: Midesophageal aortic valve long-axis view at 120–135°
The midesophageal aortic valve long-axis view at 120–135° provides an optimal plane for annular diameter measurement for TAVR sizing.
Question 6: A patient undergoing TEE is found to have an Eustachian valve. This structure represents:
- A remnant of the left valve of the sinus venosus
- A remnant of the right valve of the sinus venosus directing IVC flow (Correct answer)
- An abnormal thickening of the tricuspid valve
- A congenital defect of the interatrial septum
Correct answer: A remnant of the right valve of the sinus venosus directing IVC flow
The Eustachian valve is a normal embryologic remnant of the right valve of the sinus venosus that directed oxygenated IVC blood toward the foramen ovale in fetal life.
Question 7: On TEE, the pulmonary veins are best interrogated for flow patterns using which Doppler modality?
- Continuous-wave Doppler
- Pulsed-wave Doppler (Correct answer)
- Tissue Doppler imaging
- Color M-mode Doppler
Correct answer: Pulsed-wave Doppler
Pulsed-wave Doppler placed 1–2 cm into the pulmonary vein orifice is the standard method for assessing pulmonary venous flow patterns.
NBE Transesophageal Echocardiography 3
On TEE, a patent foramen ovale (PFO) is confirmed by: