Basic TEE Goals and Objectives

The following are goals of the basic perioperative transesophageal echocardiography education program:

  1. To achieve basic cognitive and technical skills in perioperative TEE as stated by the American Society of Echocardiography/Society of Cardiovascular Anesthesiologists guidelines.
  2. To complete 150 complete examinations under appropriate supervision of which at least 50 are personally performed, interpreted and reported by the trainee.

At the completion of this program the trainee will be able to:

  1. Describe the basic functions of the ultrasound system and techniques of image optimization.
  2. Perform a basic transesophageal echocardiographic (TEE) exam with select views.
    1. ME 4C
    2. ME 2C
    3. ME LAX
    4. ME AV LAX
    5. ME AV SAX
    6. ME RV inflow-outflow
    7. ME bicaval
    8. ME asc aortic SAX
    9. Desc aortic SAX
    10. Desc aortic LAX
    11. TG mid SAX
  3. Independently assess left ventricular systolic function, volume status and presence of extrinsic compression.
    1. Visually estimate LV ejection fraction (>55, 25-55, <25)
    2. Distinguish dilated chambers from normal-sized chambers
      1. LA enlargement
      2. LV dilation/hypertrophy
      3. HOCM and dynamic LVOT obstruction
      4. RV dilation
    3. Estimate volume status:
      1. Hypovolemia
      2. Euvolemia
      3. Hypervolemia/dilated chambers
    4. Assessment of wall motion
      1. Normal versus abnormal (hypokinetic/akinetic) wall thickening
      2. Using ME 4C, ME 2C, ME LAX, TG mid SAX views
    5. Rule out extrinsic compression
      1. Pericardial effusion present? If yes, significant or not, based on clinical correlation.
  4. Assess valve morphology and identify the presence of regurgitation or stenosis by using color flow Doppler
    1. 2D evaluation of gross valvular morphology
    2. Color flow Doppler identification of valvular stenosis or regurgitation
  5. Recognize abnormalities that would require further evaluation by an echoardiographer with advanced training in intraoperative echo.
    1. Recognize presence of any intracardiac prosthesis, including prosthetic valves, catheters, closure devices and ventricular assist devices.
    2. Recognize any possible intracardiac masses
    3. Recognize presence of aortic dissection