This deep gastric clip from a TEE shows the LVOT and can be used to measure gradients across the aortic valve.

Added by: drdavemd
Tags: gastric TEE LVOT aortic valve
Date: 2012-02-03

This TEE clip shows trace to mild aortic insufficency. The valve is tricuspid and otherwise normal.

Added by: drdavemd
Tags: TEE aortic regurg regurgitation insufficiency
Date: 2012-02-03

Normal appearance of the tricuspid valve on transesophageal echo.

Added by: drdavemd
Tags: TEE tricuspid valve
Date: 2012-02-03

accurate mesurement of left ventricular volume by biplan simpson method

Added by: drghadaatia
Tags: echo journal download
Date: 2012-01-29

This is a trial: haemodynamic measurements/ results by echocardiography in comparison with PA-cath-results. about 75 y old patient with cardiogenic shock by occlusion of RCA. Echocardiographic results: 1. contractility by mv-insufficiency: dp/dt about 320 mmHg/s (this shows a distinct impairment of left ventricle). 2. an approach to LVEDP by E/E`: about 12,7 mmHg 3. approach to CVP alternatively RAP: collapsibility of IVC: one can see, that there is no undulation/ collapsibility of IVC, diameter of IVC > 2 cm: RAP about 15-20 mmHg 4. approach to cardiac output: LVOT-VTI about 23,5 cm, LVOT-area 1,53 cm^2 (radius 0,7 cm) > stroke volume about 36 ml; heart rate: 110/min > cardiac aoutout about 3,9 l/min 5. tricupid valve (TV): Vmax: 3,4 m/sec, PAPs 35 mmHg + CVP; ATC of PV-flow 89 msec, PV-VTI 12,3 cm, one can calculates the PVR with two methods: > a. PVR= TV-flow velocity/ VTI of RVOT x 10 + 0,16; in this case you can calculate: PVR= 3,4 m/s / 0,125 m x 10 + 0,16 = 276 dyn*s*cm^-5 > b. PVR= (PAPm-PCWP)/CO x 79,9; in this case I couldn´t measure the PAPm and PAPd because I couldn´t depict a PV-insufficiency-signal by echocardiography. In comparison: the PA-cath-results: PCWP (LVEDP) 13-14 mmHg, CVP 19 mmHg, CO 4,3-4,5 l/min, PVR 285 dyn*s*cm^-5, SVR 890 dyn*s*cm^-5, cardiac power 0,71 W In my opinion is echocardiographic measurements of a few parameters a good option to approach haemodynamic in patient and to make a fast decision of therapeutical treatment in ER or ICU. I´m lookinf forward to any comment, hints, tipps and critic. That could help me to improve my skills in that kind of echocardiographic technique.

Added by: Emmel
Tags: TTE ICU echodynamic haemodynamic PA-cath
Date: 2012-01-29

about 80 y old patient with congestive heart failure and sepsis with pulmonary focus (gram-stain: gram-positive cluster coccal). In TEE we found a floating structure an posterior leaf of mital valve. not typical for active endocarditis. What could it be? We thought it could be a residual of a former endocarditis or a calcified residual of tendon of papillary muscle. What do you think?

Added by: Emmel
Tags: TEE ICU posterior mitral leaf
Date: 2012-01-28

An extended TTE should include a simple view of thoracic ECHO. Place the transducer in both parasternal higher intercostals spaces, look at the pleural line and look if ultrasound B lines are present (US B lines represent abnormal extravascular lung water, although is not strictly specific for this pathology, for example, we can encounter B lines in pulmonary fibrosis, ARDS and pulmonary contusions). In right clinical context, with echocardiography in doubt, US B lines identifies patients with lung edema and finally define diastolic disfunction. When acute respiratory failure is the diagnosis, in right clinical context, the absence of US B lines excludes a cardiogenic cause. In patients with proven diastolic disfunction, identifies lung edema and helps to intensify therapeutic options./nSo...it is very simple to do.!

Added by: ohtusabes
Tags: lung edema
Date: 2012-01-28

pericardial and pleural extension from lung sarcoma.

Added by: magehana47
Tags: tumor sarcoma pericardial
Date: 2012-01-28

TTE parasternal long axis,mmode recording and apical views ,show pericardial tumor(extension from mediastinal lymphoma),compressing the LV.

Added by: magehana47
Tags: tumor pericardial mediastinal
Date: 2012-01-28

ACUTE DECOMPENSATION OF CHRONIC RIGHT VENTRICULAR FAILURE IN A SECONDARY PULMONIC HYPERTENSION CAUSED BY CYSTIC FIBROSIS THE YOUNG PATIENT CAME TO OUR OBSERVATION AFTER AN ACUTE DECOMPENSATION OF RIGHT VENTRICULAR FAILURE . yOU NOTICE IN THE FIRST CLIP PAP 98 mmHG AND A FROZEN RIGHT VENTRICLE . aFTER ADMINISTRATION OF DILTIAZEM IV BOLUS WE OBSERFVED A DECREASE IN PULMONIC RESISTANCES PAP 65 AND A CERTAIN DEGREE OF RIGHT VENTRICULAR SISTOLIC FUNCTION IMPROVEMENT WE STARTED THEN ILOPROST MORPHINE AND CALCIUM BLOCKER IN THE DESPERATE ATTEMPT TO MANAGE THE SEVERE HYPODINAMIC STATUS . NOTICE THAT PAP VALUES WERE TIGHTLY LINKED TO PO2 VALUES . THE GIRL WAS STILL RESPONSIVE TO VASODILATORY DRUGS . ( GOOD PULMONIC VESSEL RESPONSIVITY ) ANYWAY SHE PASSED OUT AFTER 2 DAYS ICU STAY COMMENTS AND OPINION ARE REALLY APPRECIATED ESPECIALLY FROM THOSE USERS WHO ARE REALLY EXPERIENCED IN DRAMATIC ICU SCENARIOS

Added by: diego
Tags: PULMONARY HYPERTENSION
Date: 2012-01-27

This parasternal short axis TTE clip shows a patient status-post Dor procedure for a remote history of a large anterior myocardial infarction.

Added by: drdavemd
Tags: dor procedure postsurgical
Date: 2012-01-25

In this modified apical TTE clip, the right ventricle is seen near the top of the image, with the tricuspid valve in the middle and the right atrium at the bottom. The large structure on the left side of the image has the appearance of a pericardial cyst. What do you think?

Added by: drdavemd
Tags: TTE pericardium
Date: 2012-01-25

LV localized hypertrophy on the posterolateral wall ( and beneath the poterior mitral leaflet ),flail anterior leaflet and severe eccentric mitral regurgitation.left atrial and left ventricular dilatation.

Added by: magehana47
Tags: flail valve mitral regurgitation hypertrophy localized left ventricle
Date: 2012-01-18

In this side-by-side pair of transthoracic apical clips, a thrombus is clearly visualized in the LV apex. The left image is without contrast and the right image is with echo contrast.

Added by: drdavemd
Tags: echo contrast TTE apical thrombus
Date: 2012-01-18

This clip shows you the echocardiographic picture of posterolateral infarction after implantation of IABP. After 1 day of implantation of IABP PA-cath showed following results: SVR 820 dyn*s*cm^-5, cardiac output 3,8 l/min, cardiac power 0,9 W!

Added by: Emmel
Tags: TEE ICU IABP cardiac infarction cardiogenic shock
Date: 2012-01-17

about 85 y old patient with STEMI. cardiac catheter showed an occlusion of ramus circumflecus. In TTE and TEE we could see an akinesia of posterolateral wall. In PA-cath: SVR 1200 dyn*s*cm^-5, CO 2,8 l/min, cardiac power 0,51 W: this is compatible to the clinical and echocardiographic picture of cardiogenic shock! This clip shows cardiac wall movemnt disorder and restricted cardiac ejection fraction prae-implantation of IABP.

Added by: Emmel
Tags: TEE ICU posterolateral cariac infarction prä-IABP
Date: 2012-01-17

about 75 y old patient with STEMI and about 45 minutes cpr. the patient was admitted from our ER after cardiac catheter to our ICU. In cardiac catheter we found a thrombotic occlusion of left main stem, no plaques and no stenosis. in clinical history a permanent atrial fibrillation with condition after several thrombembolic strokes is known. in TEE we found a distinct cardiac wall movement disorder of left ventricle and a small parietal residual of thrombus in LAA. we think that a thrombembolic cardiac infarction caused by thrombus in LAA is the most plausible reason of this finding.

Added by: Emmel
Tags: TEE cardiogenic shock STEMI ICU
Date: 2012-01-17

about 85 y old patient with severe acute RV-failure in context of chronic ischemic RV-failure. No sign of pulmonary embolism in initial TEE and ct-scan. First TTE we found a distinct RV-wall movement disorder. haemodynamic deteriorated rapidly, so we had to start cardiac resusciation for 3 minutes. in TTE we could see a distinct rv-pressure-overload with systolic d-sign. Actually vasopressor and inotropics save the situation. Any other hints in treatment of acute RV-Failure except inotropics and/ or vasopressor?

Added by: Emmel
Tags: TTE ICU cardiac arrest rv-pressure overload cardiac resusciation
Date: 2012-01-17

about 80 y old patient with septic shock caused by severe pulmonary infection (gram-stain: gram-negative rod cells > pseudomonas). TEE showed a biventricular hypodynamic septic cardiomyopathy, beside we could see a mitral insuffiziency (2. grade; PISA 0,6), no reflux in pulmonary veins. We administered high dose catecholamines (norepinephrin, dobutamin), so we could stabilize the haemodynamic clinical situation.

Added by: Emmel
Tags: ICU TEE biventricular failure septic shock
Date: 2012-01-15

young patient with septic shock. intravenous drug consumption is known. in TTE we found a huge endocarditic vegetation on tricuspid valve. in TEE we could verified this, no vegetations on mitral, aortic or pulmonary valve. beside we could see multiple small pulmonary abscesses caused by bacterial embolizations.

Added by: Emmel
Tags: TEE endocarditis tricuspid valve ICU septic shock
Date: 2012-01-15