Upload
anscst
View
224
Download
0
Embed Size (px)
Citation preview
7/27/2019 Pitfalls in TEE Engl
1/53
Dr Stefan Scholz
The Liverpool Heart & Chest Hospital
7/27/2019 Pitfalls in TEE Engl
2/53
bicaval
RA
LA
SVC
7/27/2019 Pitfalls in TEE Engl
3/53
EmbryonicStructures
StructuresLeft Atrial Appendage
Degenerated
Aortic ValveMuscle Bundles
7/27/2019 Pitfalls in TEE Engl
4/53
AV SAX
RA
7/27/2019 Pitfalls in TEE Engl
5/53
30-60 % of adults
Associated with PFO
Associated with
Atrial Flutter
Rarely Endocarditis
bicavalIVC
7/27/2019 Pitfalls in TEE Engl
6/53
V. cava
superior
V. cavainferior
coronary
sinus
right
sinus horn
left
sinus horn
Bulbuscordis
24 days
right
sinus horn
left
sinus horn
LV RV
35 days
RA
TW Sadler : Langmans Medical Embr yology, 10th edition, Lippincott Williams & Wilkins
7/27/2019 Pitfalls in TEE Engl
7/53
Sinus
venarum
Crista
terminalis
Valve
IVC
Valve
CS
normal
prominentEustachian
Valve
Cor
triatriatum
TW Sadler : Langmans Medical Embr yology, 10th edition, Lippincott Williams & Wilkins
HD Allen et al.: Heart Disease in Infants, Children and Adolescents,
6th edition, Lippincott Williams & Wilikins
7/27/2019 Pitfalls in TEE Engl
8/53
bicavalIVC
7/27/2019 Pitfalls in TEE Engl
9/53
AV SAXRA
7/27/2019 Pitfalls in TEE Engl
10/53
bicavalSVC
= Cor triatriatrum
dexter
7/27/2019 Pitfalls in TEE Engl
11/53
bicaval
7/27/2019 Pitfalls in TEE Engl
12/53
bicaval
7/27/2019 Pitfalls in TEE Engl
13/53
4 chamber
7/27/2019 Pitfalls in TEE Engl
14/53
7/27/2019 Pitfalls in TEE Engl
15/53
bicaval
7/27/2019 Pitfalls in TEE Engl
16/53
2-10 % prevalence
Variable
Associated with
PFO (80 %) Thromboembolism
Rarely Endocarditis
7/27/2019 Pitfalls in TEE Engl
17/53
bicaval 4 chamber
normal endocarditis
7/27/2019 Pitfalls in TEE Engl
18/53
bicaval
7/27/2019 Pitfalls in TEE Engl
19/53
Separates muscular from
smooth part of RA
Causes supraventricular
Arrhythmia
AV block
SVC
IVC
Crista
terminalis
7/27/2019 Pitfalls in TEE Engl
20/53
bicaval
7/27/2019 Pitfalls in TEE Engl
21/53
1-8 % prevalence
Benign
Foramen ovale
omitted, hour glass
SupraventricularArrhythmia (> 3cm)
Cava-Obstruction
(rare)
7/27/2019 Pitfalls in TEE Engl
22/53
bicaval bicaval
increased flow
7/27/2019 Pitfalls in TEE Engl
23/53
bicaval
7/27/2019 Pitfalls in TEE Engl
24/53
Mm
pectinatae
7/27/2019 Pitfalls in TEE Engl
25/53
bicaval
Crista terminalis Mm pectinatae
7/27/2019 Pitfalls in TEE Engl
26/53
bicaval
7/27/2019 Pitfalls in TEE Engl
27/53
4 chamber
7/27/2019 Pitfalls in TEE Engl
28/53
Coronarysinus
Superiorvena cava Left brachio-
cephalic vein
Right anteriorcardinal vein
Left anterior
cardinal vein
Right commoncardinal vein
Left commoncardinal vein
Anastomosis
7th week
TW Sadler : Langmans Medical Embr yology, 10th edition, Lippincott Williams & Wilkins
7/27/2019 Pitfalls in TEE Engl
29/53
Right brachio-
cephalic vein
Cornary
sinus
Left superior
vena cava
Right superior
vena cava
Double superior
vena cava TW Sadler : Langmans Medical Embr yology, 10th edition, Lippincott Williams & Wilkins
7/27/2019 Pitfalls in TEE Engl
30/53
0.5 % of all adults
Localised between LAAand LUPV
Often asymptomatic
In childhood 40%
associated with ASD,ISTHA...
Problems with Catheters
DDx high RA pressure
4 Kammer
1cm
7/27/2019 Pitfalls in TEE Engl
31/53
left-sided injection right-sided injection
4 chamber bicavalSVC
7/27/2019 Pitfalls in TEE Engl
32/53
AV SAXLA
7/27/2019 Pitfalls in TEE Engl
33/53
Pericardial reflection
between descending
aorta and left atrium
Enlarged with extra-
cardial thrombus,pericardial effusion
DDx abscess (CD)
Transverse
sinus
7/27/2019 Pitfalls in TEE Engl
34/53
AV SAXLA
AV SAXLA
7/27/2019 Pitfalls in TEE Engl
35/53
AV SAXLA
7/27/2019 Pitfalls in TEE Engl
36/53
Often confounded with
LAA thrombus
Warfarin - Ridge
(Coumadin-
synonymous)
Variable form
AV SAXLA
LAA
LUPV
7/27/2019 Pitfalls in TEE Engl
37/53
AV SAXLA
7/27/2019 Pitfalls in TEE Engl
38/53
Analog RA
Variable Shape
DDx can be difficult
7/27/2019 Pitfalls in TEE Engl
39/53
AV SAXLA
7/27/2019 Pitfalls in TEE Engl
40/53
3D
Lobulus 1
Lobulus 2
7/27/2019 Pitfalls in TEE Engl
41/53
AV SAXLA
7/27/2019 Pitfalls in TEE Engl
42/53
AV SAXLA
7/27/2019 Pitfalls in TEE Engl
43/53
AV SAXLA
AV SAXLA
LAA Thrombus LAA bilobr
7/27/2019 Pitfalls in TEE Engl
44/53
AV SAXLA
4 Kammer
7/27/2019 Pitfalls in TEE Engl
45/53
4 chamber
7/27/2019 Pitfalls in TEE Engl
46/53
LVOT
7/27/2019 Pitfalls in TEE Engl
47/53
Along valve closure
lines (AoV, MV)
Upstream and
downstream
Up to1mm thick und
bis 5mm long
Can embolize
DDx: Fibroelastoma
(pedunculated, larger)
7/27/2019 Pitfalls in TEE Engl
48/53
LVOT
7/27/2019 Pitfalls in TEE Engl
49/53
LVOTAV SAX
LA
7/27/2019 Pitfalls in TEE Engl
50/53
4 Kammer
7/27/2019 Pitfalls in TEE Engl
51/53
4 chamber 4 chamber
LV Thrombus
7/27/2019 Pitfalls in TEE Engl
52/53
4 chamber
7/27/2019 Pitfalls in TEE Engl
53/53
Density in comparism with surroundingstructures?
Synchronous with cardiac action?
Second sign (valve regurgitation,smoke in LAA....)?