Passport to the Perioperative Transesophageal Echocardiography Rotation

By the beginning of your second week, ensure you have gone over the following learning points with an attending. Start using these in your daily echos.

High yield resources available to you include:

  • . University of Toronto Perioperative Echo (PiE) website
  • E-echocardiography.com
  • Echocardiography simulator (ILC, LKSC basement; orientation required prior to use)

TEE Views

  • Identification of all structures and ability to obtain conventional views

Ventricular assessment

  • LV segments and perfusion territories
  • RV anatomy
  • Assessment of LV systolic function (FS, FAC, MOD)
  • Assessment of RV systolic function (FAC, TAPSE)

Hemodynamics

  • Identification of sinus rhythm by TEE doppler
  • Cardiac output
  • RVSP calculation
  • Aortic valve area by continuity equation

Effusions, holes and other things

  • Pleural effusions (left and right)
  • Pericardial effusions
  • IAS interrogation for PFO
  • Normal aortic anatomy, aneurysm and dissection evaluation

Valvular Examination

  • Normal mitral, tricuspid, aortic and pulmonary valve anatomy
  • Basic interrogation of normal compared with severely diseased valves

Interventional Echocardiography

  • Central aortic and venous cannulation
  • Peripheral arterial and venous cannulation
  • Coronary sinus cannulation
  • LV vent placement
  • IABP positioning
  • Pulmonary artery catheter confirmation

Basic PTE Certification is supported by the department (Basic PTEeXAM; echoboards.org). This involves passing the written basic exam and submitting proof of at least 50 personally performed TEEs and at least 100 reviewed TEEs. The scope of practice following Basic pTEE certification is limited to non-diagnostic use within the customary practice of anesthesiology, focused on intraoperative monitoring rather than specific diagnoses. Except in emergent situations, diagnoses requiring intraoperative cardiac surgical intervention or postoperative medical/surgical management must be confirmed by an individual with advanced skills in TEE or an independent diagnostic technique. Dr Oakes or Dr Brodt are available if you have any questions about certification.

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