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1. Which of the following is a contraindication to performing a transesophageal echocardiographic examination (TEE)?

a. Asymptomatic hiatal hernia

b. Remote history of gastric ulcer

c. Large descending aortic aneurysm

d. Bleeding esophageal varices


2. Which of the following is an indication for epicardial echocardiography rather than TEE?

a. Mitral valve repair in a patient with severe dysphagia

b. Aortic valve replacement in a patient with healed gastric ulcer

c. Coronary artery bypass graft in a patient with hiatal hernia

d. Descending aortic aneurysm repair for distal descending aneurysm

a. Assessment of adequacy of MV repair necessitates echocardiographic assessment and is the classic indication for epicardial imaging of intracardiac pathology. The other procedures can be appropriately and safely assessed with TEE.

3. Which of the following imaging modalities can be used with epiaortic and epicardial imaging?

a. Two-dimensional imaging

b. Color flow Doppler

c. Spectral Doppler

d. All of the above

d. Ultrasound probes used for surface imaging have the same functionality as TEE probes for 2D, color flow Doppler, and spectral Doppler imaging. Some probes also have 3D imaging capability.

4. Which of the following is true regarding epicardial imaging?

a. Images are obtained via transthoracic approach intermittently during surgery.

b. Sterile gown and gloves are not needed by the individual obtaining images.

c. The probe is placed in a sterile sheath with sterile gel or saline.

d. Placing cold water in the mediastinal well improves image quality.

c. This is a sterile procedure that requires the operator of the probe to be gowned and gloved, and the probe must be in a sterile sheath. Cold fluid increases the risk of arrhythmias. Performing this technique also requires an individual who can manage images and store them.

5. Which of the following is a recommended epicardial view?

a. Aortic valve short axis

b. Apical four-chamber

c. Gastric long axis

d. Bicaval


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