NBE Transesophageal Echocardiography 5 — Questions and Answers
Question 1: What is the primary absolute contraindication to TEE probe insertion?
- Atrial fibrillation
- Known esophageal stricture or perforation (Correct answer)
- Anticoagulation with heparin
- Severe aortic stenosis
Correct answer: Known esophageal stricture or perforation
Known esophageal pathology such as stricture, perforation, or esophageal varices (class III) represents an absolute contraindication to TEE probe passage.
Question 2: On TEE, systolic anterior motion (SAM) of the mitral valve is most commonly associated with:
- Dilated cardiomyopathy
- Hypertrophic obstructive cardiomyopathy (Correct answer)
- Severe mitral stenosis
- Aortic regurgitation
Correct answer: Hypertrophic obstructive cardiomyopathy
SAM occurs in hypertrophic obstructive cardiomyopathy when the anterior mitral leaflet is drawn into the LVOT during systole, causing dynamic obstruction.
Question 3: 3D TEE is particularly valuable for mitral valve repair planning because it allows:
- Higher frame rate imaging than 2D TEE
- En face 'surgical view' of the mitral valve from the left atrial perspective (Correct answer)
- Continuous-wave Doppler velocity measurements
- Lower ultrasound frequency for deeper penetration
Correct answer: En face 'surgical view' of the mitral valve from the left atrial perspective
3D TEE provides a 'surgeon's view' en face image of the mitral valve that directly maps to the operative field, improving surgical planning.
Question 4: Which finding on TEE is most consistent with infective endocarditis of the mitral valve?
- Calcified mitral annulus
- Mobile echodense mass on the atrial side of the posterior leaflet (Correct answer)
- Smooth leaflet thickening without mobility
- Increased mitral valve area
Correct answer: Mobile echodense mass on the atrial side of the posterior leaflet
Infective endocarditis vegetations are mobile, irregular, echodense masses attached to the low-pressure (atrial) side of the mitral valve.
Question 5: During TEE guidance of a transcatheter mitral valve procedure, which measurement is critical for confirming transseptal puncture location?
- Distance from the coronary sinus to the puncture site
- Height above the mitral annular plane and anterior-posterior position (Correct answer)
- Aortic root diameter at the puncture level
- Distance from the SVC to the needle tip
Correct answer: Height above the mitral annular plane and anterior-posterior position
Optimal transseptal puncture requires positioning 3.5–4 cm above the mitral annular plane in the superior-posterior fossa ovalis to allow adequate catheter maneuverability.
Question 6: The 'Mercedes-Benz' sign on transgastric short-axis TEE refers to:
- Aortic valve with calcified trileaflet anatomy (Correct answer)
- Three-leaflet clover appearance of the tricuspid valve
- Appearance of a tri-leaflet mechanical prosthesis
- Trifascicular pacemaker lead pattern
Correct answer: Aortic valve with calcified trileaflet anatomy
A normal tricuspid aortic valve in the transgastric or midesophageal short-axis view resembles a Mercedes-Benz logo when all three cusps are open during systole.
Question 7: When using TEE to guide MitraClip placement, real-time guidance is primarily performed using:
- 2D midesophageal four-chamber view alone
- Biplane and 3D TEE with simultaneous orthogonal views (Correct answer)
- Transgastric short-axis view with color Doppler
- CW Doppler across the mitral valve
Correct answer: Biplane and 3D TEE with simultaneous orthogonal views
MitraClip guidance relies on biplane and real-time 3D TEE to simultaneously track the clip in two orthogonal planes and confirm leaflet grasping.
NBE Transesophageal Echocardiography 5
What is the primary absolute contraindication to TEE probe insertion?