Gradient: The Modified Bernoulli Equation

Module 1 - How are TEE images created? – The basic physics of ultrasound

Sound and ultrasound

Definitions

The characteristics of waves

Wavelength

Frequency

Amplitude

Propagation Velocity

The effects of tissue on ultrasound

Reflection

Refraction

Scatter

Attenuation

Effects of Ultrasound on Tissue

Imaging Modalities: How ultrasound images are created

Generation of a 2D image

Resolution

Principles of doppler imaging

Modes of Doppler Imaging: Overview

Pulsed Wave Doppler: Spectral Display

Pulsed Wave Doppler: Color Flow Imaging

Continuous Wave Doppler

Ultrasound Transducers

Piezoelectric Crystals

Ultrasound Transducer Design

Image Artifacts

Missing Structures

Erroneously Perceived Structures

Misplaced Structures

Conclusion

Chapter 3 - TEE Probe Manipulation and Imaging Planes

Introduction

Probe insertion and removal

Sedation

Preparation

Inserting the probe

Removing the probe

General anesthesia

Overview

Inserting the probe

Removing the probe

Contradictions and Complications

Probe manipulation

Turning to the left and right

Anteflexion and Retroflexion

Ultrasound plane rotation

Lateral flexion

Image orientation

The Perioperative Perspective

Horizontal imaging planes

Vertical imaging planes

Transgastric imaging planes

Conventional imaging planes

Chapter 4 - Measurements, Equations and Reference Values

Learning objectives

Ejection Fraction: Modified Simpson's calculation

Fractional Area Change

Fractional Shortening

Right Ventricular Systolic Pressure & Pulmonary Artery Systolic Pressure

Shunt ratio

Gradient: The Modified Bernoulli Equation

dP/dt

PISA: Proximal Isovelocity Surface Area

Regurgitant Orifice Area

Regurgitant Volume

Pressure Half Time

Underlying Principles

Mitral Valve Area by Pressure Half Time

Aortic Regurgitation Severity Assessment by Pressure Half Time

The Continuity Equation

Reference values

Mitral valve

Aortic valve

Aorta

Conclusion

Questions

Chapter 5 - The Mitral Valve

Learning objectives

Anatomy

Overview

The Annulus

Leaflet Structure

Leaflet Function

The Tendinous Cords

The Tendinous Cords

Primary, secondary and tertiary cords

Papillary Muscles

Aorto-mitral Continuity

TEE views

Mid Esophageal 4 chamber view

Mid Esophageal Mitral Commissural view

Mid Esophageal 2 Chamber view

Mid Esophageal Long Axis View

Transgastric Basal SAX view

Transgastric 2 Chamber view

Mitral Regurgitation

Introduction

Mechanisms

Introduction

Flow Convergence

Other Color Flow Doppler Methods

Spectral Dopppler

Grading Severity

Mitral Stenosis

Introduction

Mechanisms

Introduction

Spectral Doppler Assessment

Grading Severity

Conclusions

Chapter 6: The Aortic Valve

Learning objectives

Anatomy

Introduction

The Aortic Valve Annulus

The Sinuses of Valsalva

The Aortic Valve Leaflets

The Commissures

Aorto-mitral Continuity

TEE Views

Mid Esophageal Aortic Valve Short Axis

Mid Esophageal Aortic Valve Long Axis

Transgastric Long Axis

Deep Transgastric Long Axis

Aortic Stenosis

Introduction

Mechanism

Overview of Mechanisms

Calcific Aortic Stenosis

Bicuspid Aortic Stenosis

Rheumatic Aortic Stenosis

Quantification Overview

Velocity & Gradient

Aortic Valve Area

Grading Severity

Aortic Regurgitation

Introduction

Mechanisms

Overview of Mechanisms

Leaflet Abnormalities

Quantification Overview

Jet/LVOT

Continuous Wave Doppler

Descending Aorta Flow Reversal

Regurgitant Volume, Fraction and Orifice Area

Left Ventricular Size & Function

Grading Severity

Conclusion

Quiz

Chapter 7: The Left Ventricle

Introduction

Learning Objectives

Anatomy

Introduction

Segmental Anatomy

Blood Supply

TEE Views

Mid Esophageal 4 chamber view

Mid Esophageal mitral commissural

Mid Esophageal 2 chamber view

Mid Esophageal long axis view

Transgastric mid short axis

Transgastric basal short axis

Transgastric 2 chamber

Assessment of the Left Ventricle

Overview

Chamber Quantification

Overview

Cavity Dimensions

Left Ventricular Mass

Systolic Function

Fractional Shortening

Fractional Area Change

Ejection Fraction

dP/dt

Tissue Doppler Assessment

Regional Wall Assessment

Diastolic Function

Quantification Overview

Conclusion

Quiz

Chapter 8: The Right Ventricle

Introduction

Anatomy

Introduction

Apical trabecular component

Blood Supply to the Right Ventricle

Blood supply

TEE Views

Describing the right ventricle

Midesophagael Four Chamber

Midesophagael RV inflow outflow

Trangastric Mid Sax

Trangastric RV inflow

Assessment of the Right Ventricle

Overview

Dimensions

Systolic Function

Overview

Myocardial Performance Index

TAPSE

Fractional Area Change

Tricupspid Annular Velocity

dP/dt

Diastolic Function

Overview

TV inflow

Tissue Doppler Imaging

Summary

Pulmonary Artery Systolic Pressure

Grading Severity

Pathology

Overview

Volume Overload

Pressure Overload

Intrinsic Disease

Conclusion

Chapter 9: The Aorta

Introduction

Learning Objectives

Anatomy

Structure

Anatomical Relations

Vessels and Dimensions

Vessels

Dimensions

TEE Views

Overview

ME Asc Aortic SAX

ME Asc Aortic LAX

ME Desc Aortic SAX

ME Desc Aortic LAX

UE Aortic Arch LAX

UE Aortic Arch SAX

Pathology

Atheroma

Dissection

Overview

Imaging

Aneurysm

Coarctation

Intra Aortic Ballon Pump

Conclusion

Chapter 10: Other Structures of Interest

Introduction

Left Atrium, Left Atrial Appendage & Pulmonary Values

Left Atrium

Left Atrial Appendage

Anatomy of the Left Atrial Appendage

TEE Views of the Appendage

Clinical Significance

Pulmonary Veins

Pulmonary Venous Anatomy

TEE Views

Clinical Significance

Right Atrium, Atrial Septum & Cavae

Right Atrium

Superior and Inferior Cavae

Eustachian Valve & Crista

Tricuspid Valve

Tricuspid Valve Anatomy

TEE Views

Clinical Significance

Pulmonic Valve Anatomy

TEE Views

Clinical Significance

Pericardium

Conclusion

CME

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Sound and ultrasound

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