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Echo Rounds

National Board of Echocardiography Exam Applications

Echo Case

Jennie Ngai, MD1; Robert Nampiaparampil, MD1

  1. New York University Langone Medical Center, Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Perioperative Care and Pain Medicine, New York, NY

A 68-year-old male with a history of hypertension and hyperlipidemia presents with diaphoresis and chest pain. Electrocardiography showed ST elevation, and serum troponin was elevated (6 ng/ml). Emergent catheterization showed 99% occluded left anterior descending artery (LAD), 75% occluded diagonal (D1), and 99% occluded obtuse marginal (OM3). Drug eluting stents were placed in the right coronary artery (RCA) and OM3 and percutaneous transluminal coronary angioplasty (PTCA) was performed on D2 lesion. However, PTCA of mid LAD was unsuccessful. Symptoms were slightly improved after the procedure. The patient presents again 2 weeks later with dyspnea on exertion and diaphoresis. After a complete workup, including left heart catheterization, transthoracic echocardiogram, and cardiac MRI, he is scheduled for coronary artery bypass grafting. An intraoperative transesophageal echocardiogram is performed (video 1 and figure 1).

Video and Figure Legends

Video 1 and Figure 1: Trans-gastric short axis view of both ventricles showing abnormal color flow (arrow in the figure).

Figure 2: Continuous wave Doppler profile through the abnormal color flow jet.

Questions

  1. What is the turbulent flow seen in the cineloop?
    1. Aortic stenosis
    2. Ventricular septal defect
    3. Pulmonary artery stenosis
    4. Atrial septal defect
  2. The patient’s systemic blood pressure is 110/60 mmHg and HR is 90/min. What is the estimated Pulmonary Artery Systolic Pressure (PASP)?
    1. 35 mmHg
    2. 45 mmHg
    3. 55 mmHg
    4. 65 mmHg