Society of Cardiovascular Anesthesiologists

8th Annual Comprehensive Review and Update of Perioperative Echocardiography

February 14-19, 2005
Sheraton San Diego Hotel and Marina
San Diego, CA

Objectives

Monday, February 14, 2005

Cardiac Anatomy - Imagine Plane Correlation
Probe Placement and Manipulation
Upon completion of this lecture the participant should understand:

the technical aspects to facilitate probe insertion
the anatomic considerations impacting probe insertion and manipulation
the relation of the standard probe positions and normal cardiac anatomy
their correlates to the standard - "SCA 20" views
the standard probe manipulation and scan plane nomenclature

Comprehensive Examination
Upon completion of this lecture, the participant should know:

which echocardiographic views are recommended as part of a comprehensive examination
image plane nomenclature and anatomic correlation
how to manipulate a TEE probe to acquire appropriate image planes

Anatomic Imaging Plane Workshop
The purpose of this workshop is to enhance the participants understanding of the normal cardiac anatomy and TEE scan planes. The audience will be divided into multiple subgroups and distributed to work-stations at which preserved anatomical cardiac sections, corresponding scan planes and recorded TEE video exam segments will be available to facilitate these small group "tutorial" sessions. Opportunities for hands-on anatomical section examination, group participation and extensive moderator interactions will be afforded by this framework.

Luncheon
Overview presentation on the future of Echocardiography and its application to patient care

Basic Principles of TEE
Principles of Ultrasound
Upon completion of this lecture, the participant should be able to:

understand the physical principles of ultrasound
recognize ultrasound properties
explain ultrasound imaging principles

Knobology
Upon completion of this lecture, the participant should understand:

the physical principles behind the knobs on common echocardiography platforms
how to use common echocardiography platform functions to obtain 2-D and Doppler images

Artifacts
Upon completion of this lecture, the participant should understand:

the physical principles responsible for the creation of ultrasound artifacts
how to distinguish real echocardiographic images of anatomy and pathology from ultrasound artifacts
how to prevent ultrasound artifact generation

Anatomic Pitfalls
Upon completion of this lecture, the participant should be able to:

recognize commonly encountered anatomic pitfalls
distinguish anatomic pitfalls from true pathology

Basic Hemodynamics
Upon completion of this lecture, the participant should understand:

how echocardiography can be used to determine intracardiac flow and pressure gradients
pitfalls and limitations of using echocardiographic techniques to obtain hemodynamic measurements

Evening Session
Putting it all together: The Day in Review

There will be a review of the day's lectures
Presentation of two TEE "routines":
based upon probe position
based upon structure imaged
Computer simulation plus real time TEE examination

Basic Measurements and Values
At the conclusion of this lecture, the participant should understand:

the techniques and pitfalls of basic 2-D and Doppler measurements
the standard axes and planes for TEE measurements
the use of on-screen tools for 2-D and Doppler quantification

Live Demonstration of Imaging Pitfalls
At the conclusion of this symposium, the participant should understand:

how various echocardiocardiography console platforms differ
how different echocardiography platforms can be used to obtain and optimize ultrasound images

Tuesday, February 15, 2005

Basic Transesophageal Echocardiography I
LV Global Systolic Function
Upon completion of this lecture the participant should better understand:

normal LV systolic function and qualitative assessment
abnormal LV systolic function and qualitative assessment
myocardial LV segmental description and analysis
LV coronary blood flow distribution and representative TEE segments
TEE detection of myocardial ischemia
LV volume assessment

RV Global Systolic Function
Upon completion of this lecture the participant should better understand:

normal RV systolic function and qualitative assessment
abnormal RV systolic function and qualitative assessment
myocardial RV segmental description and analysis
RV coronary blood flow distribution and representative TEE segments
TEE detection of RV myocardial ischemia
RV volume assessment

Basic Diastolic Function
Upon completion of this lecture, the participant should be able to:

identify how 2-D and Doppler echocardiography can be used to define diastolic physiology
understand how echocardiographic modalities can be used to determine the etiology and extent of diastolic dysfunction
describe the utility of echocardiograph for the evaluation of perioperative diastolic dysfunction

Aortic Regurgitation
Upon completion of this lecture, the participant should understand:

structural anatomy of the normal aortic valve.
2-D echo anatomy of the normal aortic valve.
3 Anatomical pathology of aortic valve regurgitation.
mechanisms of aortic regurgitation
basic quantitative assessment of aortic regurgitation.
the diagnosis of unknown examples of AR and their quantitative assessment.

Aortic Stenosis
Upon completion of this lecture, the participant should understand:

anatomical pathology of aortic valve stenosis.
mechanisms of aortic stenosis.
basic quantitative assessment of aortic stenosis.
the diagnosis of unknown examples of AS and their quantitative assessment.

Assessment of the Aorta
Upon completion of this lecture, the participant should understand:

the standard echocardiography views used to define aortic anatomy
how perioperative echocardiography can be used to visualize and diagnose
the principles guiding the intraoperative decision-making process for patients undergoing aortic reconstruction

Luncheon: Credentialing & Certification
Upon completion of the lecture, the participant should understand:

the guidelines for training and certification in perioperative TEE including prerequisite medical knowledge and training, echocardiographic knowledge and skills, training components and duration, training environment and supervision, and equivalence requirements for post graduate physicians already in practice.

Economics of Intraoperative Echo
Upon completion of the lecture, the participant should understand:

the financial costs and benefits of an intraoperative TEE service
billing codes and requirements
report and study archival requirements
manpower requirements and support

Basic Transesophageal Echocardiography II
Mitral Regurgitation
Upon completion of this lecture, the participant should understand:

structural anatomy of the normal mitral valve.
2-D echo anatomy of the normal mitral valve.
anatomical pathology of mitral valve regurgitation.
mechanisms of mitral regurgitation.
basic quantitative assessment of mitral regurgitation.
the diagnosis of unknown examples of mitral regurgitation and their quantitative assessment.

Mitral Stenosis
Upon completion of this lecture, the participant should understand:

anatomical pathology of mitral stenosis.
mechanisms of mitral stenosis.
basic quantitative assessment of mitral stenosis.
the diagnosis of unknown examples of MS and their quantitative assessment

Tricuspid & Pulmonic Valve
Upon completion of this lecture, the participant should understand:

structural anatomy of the normal tricuspid and pulmonic valves.
2-D echo anatomy of the normal tricuspid and pulmonic valves.
anatomical pathology of tricuspid and pulmonic valvular regurgitation.
mechanisms of tricuspid valve stenosis and regurgitation.
qualitative assessment of tricuspid valve stenosis and regurgitation.
the diagnosis of unknown examples of tricuspid valve stenosis or regurgitation and their qualitative assessment.

Prosthetic Valves
Upon completion of the lecture, the participant should be able to:

identify the different types of prosthetic valves and their echocardiographic "signature".
describe the advantages and indications of each of the prosthetic valve options.
recognize the echocardiographic criteria establishing abnormal prosthetic valve function.

Basic Congenital Heart Disease
Upon completion of this lecture, the participant should understand:

normal embryological development of the heart
the echocardiographic features of commonly encountered adult congenital heart lesions
pitfalls in differentiating congenital heart lesions from normal variants
lesions to be covered include: ASD, VSD, PFO, PLSVC

Cardiac Masses
Upon completion of this lecture, the participant should understand:

how echocardiography can be used to differentiate normal cardiac structure from artifacts and pathological masses
potential physiological consequences and complications associated with intracardiac masses

Regional Wall Motion Workshop
The purpose of this workshop is to provide the participant with a more in depth understanding of:

the correlation of coronary anatomy and associated regional wall motion abnormalities in myocardial ischemia.
subtle wall motion abnormalities indicative of myocardial ischemia.

Wednesday, February 20, 2005

Cardiac Anatomy Wet Lab
Cardiac Anatomy Part 1
Upon completion of this demonstration, the participant should have a thorough understanding of:

gross external anatomy of the heart
external landmarks for cardiac anatomy
nomenclature and location of epicardial vessels
anatomic features and nomenclature of individual chambers
location of developmental anatomic remnants
location, orientation and underlying structure of different cardiac valves
anatomic relationship of the coronary circulation and conduction system to the cardiac valve structure
anatomic basis of surgical procedures and complications involving cardiac valves

TEE Correlations of Cardiac Anatomy
Upon completion of this lecture, the participant should understand the TEE correlates of the anatomical structures discussed in the previous lecture and wet-lab demonstrations including:

correlation of anatomical to echocardiographic sections
3- dimensional aspects of the heart and great vessels
correlation of probe scan planes to anatomical windows into the heart

Non-Cardiac Surgical Applications of Echocardiography
Echocardiography in the Emergency Room
Upon completion of this lecture, the participant will have a more in depth understanding of:

the role of echocardiography in the emergency room
the utility of echocardiography in diagnosing the etiology of hemodynamic instability in the emergency room setting

IntraoperativeE chocardiography for non-Cardiac/Vascular Surgery
Upon completion of this lecture, the participant should have a greater appreciation for the role of TEE in the perioperative management of non-cardiac/vascular patients including:

an understanding of the role of TEE in evaluation of patient's intravascular volume
the diagnosis of hypotension which includes: understanding the differential diagnosis of perioperative hypotension and being able to understand information about the application of echocardiography in the perioperative period to enable an etiological diagnosis of hypotension.

Echocardiography in the Intensive Care Unit
Upon completion of this lecture, the participant will have a more in depth understanding of:

the application of echocardiography in the ICU setting
the role TEE can play vs. other imaging modalities including MRI, X-ray and CT.
what supplemental information can be provided by a TEE examination vs. radiological evaluation of acute coronary syndrome and thoracic aortic disease
the application of echocardiography in the evaluation of the trauma patient
the role TEE can play vs. other imaging modalities including MRI, X-ray and CT in the acute evaluation of the trauma patient
what information can be of critical importance to emergent operative intervention and anesthetic management

Aorta and Neurocognitive Function
Upon completion of this lecture, the participant will have a better understanding of:

the role of echocardiography in evaluating aortic atherosclerotic disease as a risk factor for postoperative neurocognitive dysfunction in cardiac surgical patients
the influence of echocardiography on outcome in the evaluation of aortic disease

Assessment of Aortic Pathology
Upon completion of this lecture, the participant should understand:

how echocardiography can be used to evaluate aortic pathology including dissections and aneurysms
how echocardiograph can impact cardiac surgical decision-making during aortic reconstruction

Echocardiography in Endovascular Surgery
Upon completion of this lecture the participant should have a better understanding of:

the endovascular alternative to conventional "open" surgical procedures
the role of TEE in endovascular surgery
the image planes, measurements and logistics required for the utilization of TEE during endovascular surgery
pitfalls to be avoided

Hemodynamic Workshop
Review of Hemodynamic Principles
Upon completion of this workshop, the participant should understand:

how echocardiography can be used to measure intracardiac flow and pressure gradients
how practical echocardiographic hemodynamic measures can be used to evaluate valvular heart disease
how quantitative echocardiography can be used to guide pre- and postoperative surgical decision-making

Case Discussions:
Upon completion of this session, the participant will have a better understanding of the utility of the echocardiographic assessment of hemodynamics through interactive case studies. Participants will be presented with a series of case studies and hemodyanmic calculations will be performed and reviewed

Thursday, February 17, 2005

Advanced Echocardiography I
Advanced Systolic Function
Upon completion of this lecture, the participant should understand:

How to use echocardiography to measure normal left and right global ventricular function
How to use echocardiography to evaluate global and regional systolic dysfunction

Advanced Diastolic Function
Upon completion of this lecture, the participant should understand:

The limitation of conventional echocardiographic measures of diastolic function
Newer echocardiographic modalities for evaluating diastolic function and their potential perioperative applications

Echocardiographic Assessment of Myocardial Viability
Upon completion of this lecture, the participant should understand:

The utility of echocardiographic modalities including regional wall motion analysis, contrast and dobutamine stress echocardiography in determining perioperative myocardial viability
The impact of echocardiographic evaluation of myocardial viability on perioperative decision making

Intraoperative Assessment of the Mitral Valve
Upon completion of this lecture, the participant should understand:

How echocardiography can be used to evaluate normal anatomy of the mitral valve
How echocardiography can be used to evaluate pathological mitral valve anatomy and function
How echocardiograph can impact cardiac surgical decision-making during mitral valve procedures

Ischemic Mitral Regurgitation
Upon completion of this lecture, the participant should understand:

The pathophysiology of ischemic mitral regurgitation
The echocardiographic features of ischemic mitral regurgitation
The utility of echocardiography in the evaluation of ischemic mitral regurgitation in the perioperative period

Surgical Approach to the Mitral Valve
Upon completion of this lecture, the participant should understand:

The various surgical procedures for valve repair and restoration of mitral valve function
Impact of intraoperative transesophageal echocardiography on surgical decision-making in patients undergoing mitral valve surgery

Luncheon Series: The Future of Cardiac Surgery
Upon completion of this lecture, the participant should understand :

The future cardiac surgical techniques and procedures
The clinical implications of future cardiac surgical procedures

Advanced Echocardiography II

Three-Dimensional (3D) Echocardiography
Upon completion of this lecture, the participant should understand:

Techniques for acquiring and reconstructing 3D echocardiographic images
Techniques for acquiring Real Time 3D echocardiographic images
Perioperative applications of 3D echocardiography

Doppler Tissue Imaging, Strain and Strain Rate
Upon completion of this lecture, the participant should understand:

Techniques for acquiring Doppler tissue imaging, strain and strain rate
Applications for Doppler tissue imaging, strain and strain rate in the evaluation of myocardial performance

Transthoracic Correlates of Transesophageal Echocardiographic Images
Upon completion of this lecture, the participant should understand:

Differences and similarities between transthoracic and transesophageal echocardiographic imaging planes
Clinical applications for compact, hand-held echocardiographic consoles

Intraoperative Assessment of the Aortic Valve
Upon completion of this lecture, the participant should understand:

How echocardiography can be used to evaluate normal anatomy of the aortic valve
How echocardiography can be used to evaluate pathological aortic valve anatomy and function
How echocardiograph can impact cardiac surgical decision-making during aortic valve procedures

Surgical Options in Aortic Valve Disease
At the conclusion of this presentation, the participant should be able to recognize:

The surgical options available in patients with aortic valve disease.
The technical issues which must be addressed to insure success of each procedure.
The advantages and disadvantages of each of these procedures.
The potential complications of each of these surgical procedures.

Test Yourself
Upon completion of this session, the participant will have the opportunity to take a mock examination including both video and written questions which cover the basic principles and perioperative utility of echocardiography. The answers to the questions will be reviewed and discussed following the examination.

Friday, February 18, 2005

Role of Echocardiography in Perioperative Clinical Decision-Making

What to do About Pre-CPB 2+ MR
Upon completion of this lecture, the participant will understand

The utility of echocardiography in diagnosing clinically significant MR
How echocardiography can be used to facilitate surgical decision-making in patients who present with variable mitral regurgitation

Persistent Mitral Valve Disease Following Mitral valve Surgery: Diagnosis and Options for Intervention
Upon completion of this lecture, the participant will understand

The utility of echocardiography for diagnosing the presence and etiology of mitral valve dysfunction following mitral valve surgery
How echocardiography can be used to facilitate surgical decision-making in patients who present with mitral valve dysfunction following mitral valve surgery

Utility of Echocardiography to Facilitate Weaning from CPB
Upon completion of this lecture, the participant will have a better understanding of:

The utility of echocardiography in diagnosing the etiology of hemodynamic instability during weaning from cardiopulmonary bypass
The utility of echocardiography in determining the appropriate treatment and its effectiveness for hemodynamically unstable patients during weaning from cardiopulmonary bypass.

Congestive Heart Failure

Echocardiographic Evaluation of Cardiomyopathies
Upon the completion of this lecture the participant should understand:

The pathophysiological differences among various cardiomyopathies
How echocardiography can be used to evaluate different cardiomyopathies

Echocardiographic Evaluation of Assist Devices, Total Artificial Heart
Upon completion of this lecture the participant should understand:

the echocardiographic features of congestive heart failure and its complications
the current methods of mechanical support options available for the clinical management of end stage heart failure.
the echocardiographic assessment of each of the mechanical support procedures for end stage heart failure.

Echocardiographic Applications for Ventricular Remodeling Procedures
Upon completion of this lecture the participant should understand:

the current surgical remodeling options available for the clinical management of end stage heart failure.
echocardiographic assessment of surgical remodeling procedures of the end stage heart failure.

Luncheon Series: Future of Cardiology
Upon completion of this lecture the participant should understand:

the future of cardiology and the impact of anticipated changes in clinical and interventional cardiology on cardiac surgery

Congenital Heart Disease

Advanced Congenital Heart Disease in the Adult
Upon completion of this lecture the participant should understand:

the applications of echocardiography in diagnosing congenital heart disease in the adult
the impact of intraoperative echocardiography for congenital heart surgery in the adult

Influence of Intraoperative Echocardiography on Outcomes in the Pediatric Patient with Congenital Heart Disease
Upon completion of this lecture, the participant will have a better understanding of:

The influence of TEE on outcome in pediatric patients undergoing congenital heart surgery
Cost-effectiveness of TEE in pediatric patients undergoing congenital heart surgery

Echocardiography Options when Transesophageal Echocardiography is Contraindicated
Upon completion of this lecture, the participant should understand:

Contraindications for transesophageal echocardiography
Optional techniques for acquiring echocardiographic images when transesophageal echocardiography is contraindicated
Techniques for acquiring epiaortic and epicardial echocardiographic images
Clinical applications of epiaortic and epicardial echocardiography

Role of Echocardiography in Off Pump CABG
Upon completion of this lecture, the participant should understand:

The utility of intraoperative echo in evaluating hemodynamic function during Off Pump CABG
The impact of intraoperative echo on surgical decision making during Off Pump CABG procedures

TEE for Vascular Cannulation
Upon completion of this lecture, the participant will have a better understanding of:

How echocardiograph can be used to identify various intravascular canulae and distinguish them from artifact and normal structures
How echocardiography can used to facilitate guidance of vascular cannula placement and positioning

Saturday, February 19, 2005

You're the Intraoperative Echocardiography Consultant: Case Discussions with the Experts
Upon completion of this session, the participant will have a better understanding of:

How to be a perioperative echocardiography consultant
Utility of echocardiography for perioperative decision-making through the use of interactive case discussions

Online registration is now closed. You may register on-site at the meeting.