Normal and Abnormal Appearance of Cardiac Devices

Normal and Abnormal Appearance of Cardiac Devices
Normal and Abnormal Appearance of Cardiac Devices
1. Based on the echo images (Fig. 32.1, Video 32.1) and the
parasternal long-axis and apical four-chamber view, which
of the following statements is true?
A. The patient has a secundum atrial septal defect.
B. The patient has l-transposition of the great arteries.
C. The patient has a pacemaker/debrillator lead in the
pulmonic ventricle.
D. The pulmonic valve is anterior and to the left of the
aortic valve.
2. A patient with recent mitral valve surgery 2 weeks prior
presents with shortness of breath but normal pulmonary
pressures. The gradient across the MV is 15 mm Hg. A
TEE is performed, and the images are obtained (Fig. 32.2,
Video 32.2). The patient has been compliant on Coumadin,
and his INR is 2.5. What is the appropriate next step in
management?
Chapter 32
Normal and Abnormal
Appearance of Cardiac
Devices
Edward A. Gill and Andrew Cheng
Figure 32.1 A: Parasternal long-axis view of a patient with d-transposition
of the great vessels. The purpose of this image is to show that the aortic
and pulmonic valves are in the same plane. B: Apical view of a patient
with d-transposition of the great arteries. The morphologic right ventricle
is enlarged and is functioning as the systemic ventricle, pumping blood
through the aortic valve to the systemic circulation.
Figure 32.2 A: TEE during systole. Shown is a St. Jude valve in the
mitral position. Note the position of the mitral valve leaflets. This is a
systolic frame. B: TEE during diastole. Shown is a St. Jude valve in the
mitral position. The more medial leaflet does not open completely in
diastole.
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Chapter 32 Normal and Abnormal Appearance of Cardiac Devices 277
A. Start heparin drip and increase Coumadin to obtain a
target of 3.0 to 3.5.
B. Obtain blood cultures, and start antibiotics. Repeat
echo in 6 weeks.
C. Seek CT surgery consultation.
D. Order a bicycle stress test, and evaluate pulmonary
pressures with exercise.
3. A patient with a history of a prosthetic aortic valve presents to the ER with tachycardia and hypotension. A 2/6
diastolic murmur is heard at the RUSE. The echo in
Figure 32.3A and B and Video 32.3 is obtained.
Continuous-wave Doppler …ow was consistent with moderate
AR. What is the appropriate next step in management?
A. Take the patient to the OR to replace valve.
B. Obtain blood cultures, and start antibiotics.
C. Perform a TEE.
D. Order a left heart cardiac catheterization.
4. A patient with a history of a Ross procedure for congenital aortic stenosis presents with fevers. He had a dental
cleaning 1 week ago. The echo in Figure 32.4A and B
was obtained. Doppler tracing is shown in Figure 32.4C.
The patient’s BP is 115/60 with HR of 80. What is the
most appropriate next step in management?
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