TEE Quiz

1. Name the structure pointed by the arrow..

Tricuspid Valve

Aorta

Pulmonary Valve

Right Ventricle

Aortic Valve

This is Mid-oesophageal RV inflow outflow veiw. Shows RV free wall at the bottom of the screen. Very useful view to assess TR, RV function, Doppler measurements across TV, Gradient across RVOT using CFM etc

Explanation

This is Mid-oesophageal RV inflow outflow veiw. Shows RV free wall at the bottom of the screen. Very useful view to assess TR, RV function, Doppler measurements across TV, Gradient across RVOT using CFM etc

2. All are true about TAPSE except,

Tricuspid Annular Plane Systolic Excursion

It is a reliable measure of RV systolic function

Normal TAPSE is 20 – 25 mm

TAPSE is measured at the septal aspect of tricuspid annulus

Can be measured using either the M- mode or 2D echo

TAPSE is not measured at the septal aspect of the tricuspid annulus.

Explanation

TAPSE is not measured at the septal aspect of the tricuspid annulus.

3. The most probable order of leaflet segments from left to right in this view..

P1, P2, P3

A1, P2, A3

P3, A2, P1

P!, A2, P3

A3, P2, A1

This is ME bicommissural view it shows P3, A2, P1 segments. If P2 is prolapsing then it will be seen above A2 during systole.

Explanation

This is ME bicommissural view it shows P3, A2, P1 segments. If P2 is prolapsing then it will be seen above A2 during systole.

4. What is being measured here?

Systolic index of contractility

Mitral inflow velocity

Diastolic index of contractility

Severity of mitral regurgitation

Severity of mitral stenosis

The correct answer is Systolic index of contractility. This is because the question is asking what is being measured, and the systolic index of contractility refers to the strength and efficiency of the heart's contraction during the systolic phase of the cardiac cycle.

Explanation

The correct answer is Systolic index of contractility. This is because the question is asking what is being measured, and the systolic index of contractility refers to the strength and efficiency of the heart's contraction during the systolic phase of the cardiac cycle.

5. Doppler spectrum is due to ..

Flow across pulmonary Valve

Flow across Tricuspid Valve

Flow across Mitral Valve

Flow across Aortic Valve

The Doppler beam is across Aortic Valve in this Deep Transgastric view of LVOT and AV

Explanation

The Doppler beam is across Aortic Valve in this Deep Transgastric view of LVOT and AV

6. The following statements about the normal mitral valve are all true, except

Posterior annulus is more prone to dilatation in pathologic conditions

Annulus stays saddle shaped throughout the cardiac cycle

The posterior leaflet has larger annular attachment than anterior leaflet

ME Bicommissural and ME LAX views are aligned to major and minor axes of mitral annulus respectively

Annulus becomes circular during systole.

Explanation

Annulus becomes circular during systole.

7. The marker is at..

Aorta

Right pulmonary artery

Left pulmonary artery

Main pulmonary artery

Right pulmonary vein

Mid esophageal aortic short axis view showing MPA to its left and RPA above.

Explanation

Mid esophageal aortic short axis view showing MPA to its left and RPA above.

8. The marker is at..

Mitral Valve

Tricuspid Valve

Aortic Valve

Pulmonary Valve

Transgastric short axis view of tricuspid valve.

Explanation

Transgastric short axis view of tricuspid valve.

9. Which segment of LV is to the left of the screen?

Lateral

Septal

Inferior

The segment of LV that is to the left of the screen is the Inferior segment.

Explanation

The segment of LV that is to the left of the screen is the Inferior segment.

10. Which segment of leaflet is being pointed by the arrow..

A3

A2

P1

P2

P3

The segment of the leaflet being pointed by the arrow is P3.

Explanation

The segment of the leaflet being pointed by the arrow is P3.

11. Which of the following statements concerning determination of stroke volume using Doppler is incorrect..

VTI and Area should be determined at the same location

LVOT, AV, Ascending aorta and Main Pulmonary artery are all equally suitable for measuring stroke volume

The spatial flow velocity profile should be flat

VTI should be determined with ultrasound beam parallel to blood flow

VTI and area should be determined during mid systole

The incorrect statement is that LVOT, AV, Ascending aorta and Main Pulmonary artery are all equally suitable for measuring stroke volume. In reality, the LVOT (Left Ventricular Outflow Tract) is the most commonly used location for measuring stroke volume using Doppler. This is because it provides a reliable and accurate measurement of blood flow velocity. The other locations mentioned may not provide the same level of accuracy or consistency in measuring stroke volume.

Explanation

The incorrect statement is that LVOT, AV, Ascending aorta and Main Pulmonary artery are all equally suitable for measuring stroke volume. In reality, the LVOT (Left Ventricular Outflow Tract) is the most commonly used location for measuring stroke volume using Doppler. This is because it provides a reliable and accurate measurement of blood flow velocity. The other locations mentioned may not provide the same level of accuracy or consistency in measuring stroke volume.

12. This kind of Doppler velocity profile is seen in

Left ventricular Hypertrophy

Mitral stenosis

Tricuspid regurgitation

Mitral regurgitation, in early stages

Hypovolemia

This transmitral Pulse Wave Doppler is showing Stage 1 diastolic dysfunction where E LVH is one of the commonest causes for this.

Explanation

This transmitral Pulse Wave Doppler is showing Stage 1 diastolic dysfunction where E LVH is one of the commonest causes for this.

13. Which Chamber..

Right Ventricle

Left Ventricle

Right Atrium

Left Atrium

Pulmonary artery

This is Transgastric RV inflow view. The valve seen is Tricuspid Valve

Explanation

This is Transgastric RV inflow view. The valve seen is Tricuspid Valve

14. What other measurements are usually done along with this..

Mitral annulus diameter

Leaflet heights and their ratio

Coaptation height

Septal thickness

Left ventricular dimensions

Leaflet heights are done along with C-sept measurement.
If C-sept is 1.5cms, then possibility of patient having systolic anterior motion and LVOT obstruction after MV repair is very high.

Explanation

Leaflet heights are done along with C-sept measurement.
If C-sept is 1.5cms, then possibility of patient having systolic anterior motion and LVOT obstruction after MV repair is very high.

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16. What Carpentier class of leaflet motion..

Class I

Class II

Class III A

Class IIIB

Class I - Normal leaflet motion
Class II - Increased leaflet motion
Class III A - Decreased leaflet motion in throughout cardiac cycle
Class III B - Decreased leaflet motion only in systole
This is a case of severe MS with restriction of both leaflets during both systole and diastole.

Explanation

Class I - Normal leaflet motion
Class II - Increased leaflet motion
Class III A - Decreased leaflet motion in throughout cardiac cycle
Class III B - Decreased leaflet motion only in systole
This is a case of severe MS with restriction of both leaflets during both systole and diastole.