NBE Transesophageal Echocardiography 4 — Questions and Answers
Question 1: Which TEE finding is most specific for cardiac tamponade physiology?
- Large pericardial effusion with bright fibrin strands
- Right atrial free wall collapse during systole
- Left ventricular diastolic collapse (Correct answer)
- Dilated inferior vena cava without respiratory variation
Correct answer: Left ventricular diastolic collapse
Left ventricular diastolic collapse is the most specific echocardiographic sign of cardiac tamponade, though right chamber collapse is more sensitive.
Question 2: On TEE, mitral valve prolapse is defined as leaflet displacement into the left atrium of at least:
- 2 mm beyond the mitral annular plane
- 5 mm beyond the mitral annular plane (Correct answer)
- The coaptation point
- 1 mm in any TEE view
Correct answer: 5 mm beyond the mitral annular plane
Mitral valve prolapse on echocardiography is defined as ≥2 mm systolic displacement of leaflet tissue above the mitral annular plane in the long-axis view, but the classic criterion often cited is 5 mm for classic MVP.
Question 3: Which TEE view provides the best assessment of the subvalvular mitral apparatus including papillary muscles?
- Midesophageal four-chamber view
- Transgastric two-chamber view (Correct answer)
- Upper esophageal aortic arch view
- Midesophageal commissural view
Correct answer: Transgastric two-chamber view
The transgastric two-chamber view places the probe close to the LV apex, providing excellent visualization of papillary muscles and chordae tendineae.
Question 4: In assessing aortic dissection by TEE, which finding confirms the diagnosis?
- Aortic regurgitation with central jet
- Visualization of an intimal flap separating true and false lumen (Correct answer)
- Dilated aortic root > 4.5 cm
- Pericardial effusion adjacent to the aorta
Correct answer: Visualization of an intimal flap separating true and false lumen
An intimal flap creating true and false lumens is the definitive TEE finding for aortic dissection.
Question 5: During intraoperative TEE for mitral valve repair, a residual regurgitant jet with vena contracta > 3 mm after weaning from bypass indicates:
- Acceptable repair result requiring no further intervention
- Need to return to bypass for revision (Correct answer)
- Normal post-repair physiology
- Systolic anterior motion artifact
Correct answer: Need to return to bypass for revision
A vena contracta > 3 mm post-repair indicates significant residual MR and typically warrants return to cardiopulmonary bypass for revision.
Question 6: The transgastric short-axis view at the level of the papillary muscles is primarily used intraoperatively to monitor:
- Aortic valve function
- Regional left ventricular wall motion for ischemia (Correct answer)
- Tricuspid valve coaptation
- Pulmonary artery pressures
Correct answer: Regional left ventricular wall motion for ischemia
The transgastric mid-papillary short-axis view provides real-time assessment of all three major coronary territories for new wall motion abnormalities indicating ischemia.
Question 7: Which TEE Doppler pattern in the pulmonary veins suggests elevated left atrial pressure?
- Dominant S wave with S/D ratio > 1
- Dominant D wave with blunted or reversed S wave (Correct answer)
- Prominent A-wave reversal > 35 cm/s
- Biphasic S wave with normal D wave
Correct answer: Dominant D wave with blunted or reversed S wave
Blunting or reversal of the systolic (S) wave with dominant diastolic (D) flow indicates elevated left atrial pressure or reduced LV compliance.
NBE Transesophageal Echocardiography 4
Which TEE finding is most specific for cardiac tamponade physiology?