Perioperative Echocardiography Education

Toronto General Hospital Department of Anesthesia & Pain Management

Resources

Course Logistics

Other PTE courses on-line

  1. University of Utah, Perioperative Echocardiography Education

3D Model & Image Collections

  1. Normal Cardiac Anatomy (including the whole heart blood pool model)
  2. Toronto Adult Congenital Heart Disease Atlas
  3. Congenital Heart Disease diagrams from chd-diagrams.com (open source – cc-by license)
  4. Toronto General Hospital, Perioperative Interactive Education
  5. Wikimedia heart illustrations and video clips (open source – cc-by license) – See specifically the excellent images by P. Lynch.

Echo Simulators On-line

  1. APIL Echocardiography Simulator (TEE and TTE)

2019 Introduction to Perioperative TEE Series

Lecture 1: TEE Views (July 10)

Format: Live Lecture; (A. Omran)

  1. Omran – TEE Views (PPTX) (PDF)

References

  1. Reeves ST, Finley AC, Skubas NJ, Swaminathan M, Whitley WS, Glas KE, et al. Basic perioperative transesophageal echocardiography examination: a consensus statement of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr [Internet]. 2013 May;26(5):443–56.
  2. Hahn RT, Abraham T, Adams MS, Bruce CJ, Glas KE, Lang RM, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr [Internet]. 2013 Sep;26(9):921–64.
  3. Puchalski MD, Lui GK, Miller-Hance WC, Brook MM, Young LT, Bhat A, et al. Guidelines for Performing a Comprehensive Transesophageal Echocardiographic Examination in Children and All Patients with Congenital Heart Disease: Recommendations from the American Society of Echocardiography. Journal of the American Society of Echocardiography [Internet]. 2019 Feb [cited 2019 Feb 6];32(2):173–215.

Lecture 2: Comprehensive TEE Exam including Spectral and Color Doppler (July 17)

Format: Live Lecture; (A. Omran)

  1. Omran – Comprehensive TEE Exam and Doppler Echocardiography (PPTX) (PDF) Includes MCQ Quiz

Lecture 3: Mitral Valve: Anatomy, Imaging, Pathology (July 24)

Format: Live Lecture; (A. Omran)

  1. Omran – Mitral Valve: Anatomy, Imaging and Pathology (PPTX) (PDF) Includes MCQ Quiz

References

  1. Omran AS, Woo A, David TE, Feindel CM, Rakowski H, Siu SC. Intraoperative transesophageal echocardiography accurately predicts mitral valve anatomy and suitability for repair. Journal of the American Society of Echocardiography. 2002 Sep;15(9):950–7. Access via Sci-Hub DOI: 10.1067/mje.2002.121534
  2. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease. Journal of the American College of Cardiology. 2017 Jul;70(2):252–89.
  3. Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA, et al. Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017 Apr;30(4):303–71.
  4. Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr. 2009 Jan;22(1):1–23; quiz 101–2.

Lecture 4: Aortic Valve: Anatomy, Imaging, Pathology (July 31)

Format: Live Lecture; (A. Omran)

  1. Omran – Aortic Valve: Anatomy, Imaging and Pathology (PPTX) (PDF) Includes MCQ Quiz

References

  1. Ouzounian M, Feindel CM, Manlhiot C, David C, David TE. Valve-sparing root replacement in patients with bicuspid versus tricuspid aortic valves. The Journal of Thoracic and Cardiovascular Surgery. 2019 Jul;158(1):1–9.
  2. Mazine A, El-Hamamsy I, Verma S, Peterson MD, Bonow RO, Yacoub MH, et al. Ross Procedure in Adults for Cardiologists and Cardiac Surgeons. Journal of the American College of Cardiology. 2018 Dec;72(22):2761–77.
  3. Goldstein SA, Evangelista A, Abbara S, Arai A, Asch FM, Badano LP, et al. Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography. 2015 Feb;28(2):119–82.

Lecture 5: Tricuspid and Pulmonic Valves: Anatomy, Imaging, Pathology (August 7)

Format: Live Lecture; (A. Omran)

  1. Omran – Tricuspid Valve: Anatomy, Imaging and Pathology (PPTX) (PDF) Includes MCQ Quiz

References

  1. Hung J, Elmariah S. The Forgotten Valve Finally Gets Some Respect. JACC: Cardiovascular Imaging [Internet]. 2019 Mar;12(3):398–400.
  2. Dahou A, Levin D, Reisman M, Hahn RT. Anatomy and Physiology of the Tricuspid Valve. JACC: Cardiovascular Imaging. 2019 Mar;12(3):458–68.
  3. da Silva JP, Baumgratz JF, da Fonseca L, Franchi SM, Lopes LM, Tavares GMP, et al. The cone reconstruction of the tricuspid valve in Ebstein’s anomaly. The operation: early and midterm results. The Journal of Thoracic and Cardiovascular Surgery. 2007 Jan;133(1):215–23.

Lecture 6: Systolic Ventricular Function: function of LV and RV (August 14)

Format: Live Lecture; (A. Omran)

  1. Omran – Systolic Ventricular Function: LV and RV (PTEX) (PDF)

References

  1. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015 Jan;28(1):1-39.e14.

Lecture 7: Cardiomyopathy HOCM and others (August 21)

Format: Live Lecture; (A. Omran)

  1. Omran – Cardiomyopathies (PTEX) (PDF)

Lecture 8: Basic Hemodynamics (August 28)

Format: Live Lecture; (A. Omran)

  1. Omran – Basic Hemodynamics(PTEX) (PDF)

References

  1. Baumgartner H, Hung J, Bermejo J, Chambers JB, Edvardsen T, Goldstein S, et al. Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Journal of the American Society of Echocardiography. 2017 Apr;30(4):372–92.
  2. Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr. 2009 Jan;22(1):1–23; quiz 101–2.
  3. Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA, et al. Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017 Apr;30(4):303–71.

2019 Perioperative TEE NBE Exam Preparation Course

Week 1 – Anatomy for Echocardiography

Format: Recorded Lecture; 3 segments. (A. Mashari)

Part 1: Morphology of the heart base

Human Heart Base by APIL

Part 2: Orientation of heart base in thorax; chambers, major vessels, relationship to esophagus & airway

Whole Heart Blood Pool Model by APIL

Standard echocardiographic imaging planes in 3D (12 clips)

Part 3: 3D Slicer Tutorial

Links

  • 3D Slicer: http://Slicer.org (Download the “stable” version)

  • 3D Cardiac CT and segmentation models for 3D Slicer

References

General
  1. Zimmerman, Basic Cardiac Anatomy for the Echocardiographer (Recorded lecture from University of Utah Perioperative Echocardiography Education)
  2. McGiffin D. Cardiac Anatomy.
  3. Faletra FF, Ho SY, Leo LA, Paiocchi VL, Mankad S, Vannan M, et al. Which Cardiac Structure Lies Nearby? Revisiting Two-Dimensional Cross-Sectional Anatomy. Journal of the American Society of Echocardiography. 2018 Sep 1;31(9):967–75.
Heart Base
  1. Zimmerman J. The Functional and Surgical Anatomy of the Heart. Hunterian Lecture; 1966 Jan 13; Royal College of Surgeons of England.
Chambers and Orientation Terminology
  1. Partridge JB, Anderson RH. Left ventricular anatomy: its nomenclature, segmentation, and planes of imaging. Clin Anat. 2009 Jan [cited 2011 Feb 21];22(1):77–84.
  2. Anderson RH, Cook AC. The structure and components of the atrial chambers. Europace. 2007 Nov 1 [cited 2015 Dec 18];9(suppl 6):vi3–9.
  3. Anderson RH, Loukas M. The importance of attitudinally appropriate description of cardiac anatomy. Clin Anat. 2009 Jan; 22(1):47–51.
Coronary arteries
  1. Loukas M, Groat C, Khangura R, Owens DG, Anderson RH. The normal and abnormal anatomy of the coronary arteries. Clin Anat. 2009 Jan;22(1):114–28.
  2. Chiu I-S, Anderson RH. Can we better understand the known variations in coronary arterial anatomy? Ann Thorac Surg. 2012 Nov;94(5):1751–60.
Embryology
  1. Moorman A, Webb S, Brown NA, Lamers W, Anderson RH. Development of the heart: (1) Formation of the cardiac chambers and arterial trunks. Heart. 2003 Jul 1 ;89(7):806–14.
  2. Anderson RH, Webb S, Brown NA, Lamers W, Moorman A. Development of the heart: (2) Septation of the atriums and ventricles. Heart. 2003;89(8):949–58.
  3. Anderson RH, Webb S, Brown NA, Lamers W, Moorman A. Development of the heart: (3) Formation of the ventricular outflow tracts, arterial valves, and intrapericardial arterial trunks. Heart. 2003;89(9):1110–8.

Week 2 – Artifacts and Pitfalls

Format: Live Presentation (A. Vegas)

  1. Vegas – Handout 1 – Pitfalls (PDF) (PPTX) 
  2. Vegas – Handout 2 – Physics of Artifacts (PDF) (PPTX)

Week 3 – The Basic TEE Screening Examination & Rescue TEE

Format: Live Presentation (C. Hudson)

  1. Hudson –  Slides – Rescue TEE (PDF)

References

Perioperative TEE

  1. ** Basic Perioperative Transesophageal Echocardiography Examination: A Consensus Statement of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists, JASE, May 2013
  2. * ASE/SCA Guidelines for Performing a Comprehensive Intraoperative Multiplane Transesophageal Examination, JASE, October 1999.

General TEE

  1. * Guidelines for Performing a Comprehensive Transesophageal Echocardiography Examination: Recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists, JASE, September 2013 (ASE Webinar)

TTE

  1. * Focused Cardiac Ultrasound: Recommendations from the American Society of Echocardiography, JASE, June 2013
  2. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults, JASE, January 2019

Other References

  1. Denault A, Vegas A, Royse C. Bedside clinical and ultrasound-based approaches to the management of hemodynamic instability–part I: focus on the clinical approach: continuing professional development. Can J Anaesth. 2014 Sep;61(9):843–64.
  2. Vegas A, Denault A, Royse C. A bedside clinical and ultrasound-based approach to hemodynamic instability – Part II: bedside ultrasound in hemodynamic shock: Continuing Professional Development. Can J Anaesth. 2014 Nov;61(11):1008–27.

Week 4 – Review Session: Ultrasound Physics

Format: Live Review Session – Survival rates variable (A. Mashari)

  1. Mashari – Ultrasound Physics Questions and Answers (PDF)

References

  1. Basic ultrasound for clinicians
  2. Hunting Bats (Video)
  3. An Interactive Guide to the Fourier Transform
  4. PTEmasters, Physics of Ultrasound (11 parts)
  5. Edelman SK. Understanding Ultrasound Physics. 3rd ed. ESP; 2003.
  6. Fish P. Physics and Instrumentation of Diagnostic Medical Ultrasound. Wiley; 1990. 268 p.
  7. Miele FR. Ultrasound Physics and Instrumentation. 4th ed. Forney, TX: Miele Enterprises, Inc.; 2006.
  8. Thomas JD, Rubin DN. Tissue harmonic imaging: why does it work? J Am Soc Echocardiogr. 1998 Aug;11(8):803–8.

Week 5 – Rheumatic Heart Disease, Mitral Stenosis

Format: Live Presentation (A. Vegas)

  1. Vegas – Rheumatic Heart Disease and Mitral Stenosis (PDF) (PPTX)

Week 6 – Aortic Stenosis, LVOT Obstruction and Hypertrophic Cardiomyopathy; Review session

Format: Recorded Presentation (J. Moreno); Live Review Session (B. Ansari)

Part 1: Aortic Valve Stenosis

Part 2: Hypertrophic Cardiomyopathy and LVOT Obstruction

References

  1. Baumgartner H et al. Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. JASE. 2017 Apr;30(4):372–92. (ASE Webinar)
  2. Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. JASE. 2009 Jan;22(1):1–23; quiz 101–2.

Week 7 – Aortic Valve Insufficiency & Aortic Valve Repair; Review session

Format: Recorded Presentation; Live Review Session (J. Fiorellino)

  1. Bledsoe (2016) Evaluation of Aortic Insufficiency (from University of Utah Perioperative Echocardiography Education)

Week 8 – Intracardiac Masses & Devices

Format: Live Presentation (A. Snyman)

  1. Snyman – Cardiac Masses (PDF) (PPTX)

References

  1. Tower-Rader A, Kwon D. Pericardial Masses, Cysts and Diverticula: A Comprehensive Review Using Multimodality Imaging. Progress in Cardiovascular Diseases. 2017 Jan 1;59(4):389–97.
  2. Saric M, Armour AC, Arnaout MS, Chaudhry FA, Grimm RA, Kronzon I, et al. Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism. JASE. 2016 Jan 1;29(1):1–42.
  3. Peters PJ, Reinhardt S. The Echocardiographic Evaluation of Intracardiac Masses: A Review. JASE. 2006 Feb 1;19(2):230–40.

Week 9 – Left Ventricle Assessment; Review session

Format: Recorded Presentation (PTE Masters LV Basic, Additional Topics and Advanced); Live Review Session (C. Srinivas)

  1. Bledsoe (2017) Left Ventricular Quantification and Systolic Function (from University of Utah Perioperative Echocardiography Education)
  2. Curtis (2016) Segmental Wall Motion Abnormalities & Ischemia  (from University of Utah Perioperative Echocardiography Education)

Week 10 – Mitral Valve Insufficiency and Mitral Valve Repair

Format: Recorded Presentation (University of Utah Collection)

  1. Zimmrman, Anatomy of the Mitral Valve Apparatus (from University of Utah Perioperative Echocardiography Education)
  2. Birgenheier, Mitral Regurgitation (2 parts) (from University of Utah Perioperative Echocardiography Education)

Week 11 – ACHD 1: Fontan Circulation

Format: Live Presentation (J. Heggie)

  1. Heggie (2019) Fontan Circulation

Week 12 – Pericardium; Review Session

Format: Recorded Presentation (University of Washington; PTE Masters); Live Review Session (C. Hudson)

Part 1: Physiology

An excellent case presentation and discussion on the physiology of pericardial disease and the difference between constriction by the pericardium vs. myocardial restriction. From University of Washington.

Part 2: Echocardiographic Evaluation

  1. See PTE Masters lectures “Pericardial Disease” Parts 1-8

Week 13 – ACHD 2: Unrestricted Shunts

Format: Live Presentation (J. Heggie)

Week 14 – TEE for Aortic Surgery; Epiaortic Imaging

Format: Live Presentation (C. Srinivas)

  1. Srinivas – TEE For Aortic Surgery (PDF)

Week 15 – Right Heart: RV function, Tricuspid and Pulmonary Valve Assessment

Format: Recorded Presentation (University of Utah Collection) and Live review of studies by Dr. Jariani

  1. Silverton (2016) Right Heart Function (from University of Utah Perioperative Echocardiography Education)
  2. Bledsoe (2015) Evaluation of RV Function (from University of Utah Perioperative Echocardiography Education)
  3. Gnadinger (2016) Tricuspid and Pulmonary Valve Assessment (from University of Utah Perioperative Echocardiography Education)

Week 16 – Hemodynamic Calculations

Format: Live Review Session (Dr. Moreno)

Week 17  – ACHD – Contotruncal Abnormalities

Format: Live Presentation (J. Heggie)

Week 18  – TEE for Advanced Heart Failure: LVAD, ECLS, Transplant, Contrast echo

Format: Live Presentation (A. Snyman)

Week 19 – ACHD – Transposition of Great Arteries

Format: Live Presentation (J. Heggie)

Week 20 –  Mock Exam

Format: On-line Mock Exam (A. Mashari); Live Review Session (A. Omran)

  1. Mock Exam
  2. Omran – Mock Exam Review (PDF) (PPTX)

Week 21 – Study Week

Week 22 – TEE for Structural Heart Disease Interventions: TAVI, TEVAR, Trans-Septal Puncture

Format: Live Presentation (A. Omran)

  1. Omran-TEE for Structural Heart Disease Interventions (PDF) (PPTX)

Week 23 – Equipment, Infection Control, and Safety

Format: Recorded Presentation (J. Moreno)

Week 24 – Review

Format: Live Review Session (J. Moreno)

Week 25 – Diastolic Function & Cardiomyopathies (except HOCM)

Format: Live Review Session (A. Omran)

  1. Omran – Diastolic Function and Cardiomyopathies (PDF) (PPTX)

Other Topics

3D Echo

  1. Lang RM et al. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. JASE. 2012 Jan;25(1):3–46. (Lecture by Dr. Lang)
  2. Simpson J et al. Three-dimensional Echocardiography in Congenital Heart Disease: An Expert Consensus Document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. JASE. 2017 Jan;30(1):1–27.

Congenital Heart Disease

  1. Puchalski MD et al. Guidelines for Performing a Comprehensive Transesophageal Echocardiographic. JASE. 2019 Feb;32(2):173–215.
  2. Simpson J et al. Three-dimensional Echocardiography in Congenital Heart Disease: An Expert Consensus Document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. JASE. 2017 Jan;30(1):1–27.
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