Echo Week - Learning Objectives

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1 Echo Week - Learning Objectives Sunday, February pm Physics Review Moderator: Mark Taylor, MD 1. Understand the ultrasound physics and apply it to image creation and optimization 2. Infer the interaction of ultrasound with tissue 3. Differentiate the imaging requirements between two-dimensional (2D) and Doppler echocardiography 4. Illustrate the differences between pulse wave Doppler (PWD), and continuous wave Doppler (CWD) for assessment of flow, hemodynamics and volume estimation 5. Comprehend CFD principles and apply for assessment of flow and hemodynamic assessment 7-8 pm Echo Week Pre-Test Moderator: Feroze Mahmood, MD Monday, February 26 7:30 9 am Principles of Hemodynamics Moderator: Mark Taylor, MD 1. Understand the echocardiographic applications which underlie hemodynamic principles 2. Utilize 2D, PWD, CWD to calculate blood flow and intra-cardiac shunts, gradients and valve areas 3. Differentiate and classify various levels of severity of valvular dysfunction. 4. Infer intra-cardiac chamber pressures from Doppler derived variables. 9:30 11:30 am Left Ventricle Moderator: Fabio Papa, MD 1. Identify normal and abnormal left ventricular (LV) function. Page 1 of 7

2 2. Apply qualitative and quantitative methods to assess LV systolic function. 3. To recognize the importance of diastolic function assessment in the perioperative setting and perform both qualitative and quantitative Doppler analysis of diastolic function. 12:30-2 pm Right Ventricle Moderator: Massimiliano Meineri, MD 1. Recognize various components right ventricular (RV) anatomy. 2. Compare and contrast RV anatomy with LV anatomy. 3. Apply qualitative and quantitative assessment RV systolic function. 4. To recognize the importance of diastolic function assessment in the perioperative setting and perform both qualitative and quantitative Doppler analysis of RV diastolic function. 2:30 4 pm Principles of Tissue Doppler and Cardiac Kinetics Moderator: Andrew Maslow, MD 1. Describe the limitations of current 2D and 3D imaging modalities to determine myocardial structure and function. 2. Illustrate the incremental value of tissue Doppler in assessment of myocardial function. 3. Define the rationale for strain assessment. 4. Explain the methods for assessing strain during a complete echocardiographic assessment. 5. Summarize the value of tissue Doppler and strain imaging in perioperative applications. 4:30-6:30 pm Potpourri Moderator: Jonathan Leff, MD 1. Assess the anatomy and evaluate the left and right atria. 2. Explain the anatomy of venous and arterial structures using TEE and direct surface scanning. 3. Identify common echocardiographic artifacts. 4. Recognize echocardiographic findings suggestive of endocarditis. 5. Distinguish common normal variants and unusual findings by echocardiography. 6. Explain the 2D and Doppler characteristics for assessment of pericardial diseases. 6:30-7:30 pm Day in Review Presenter: Peter Panzica, MD 1. Assess their acquisition of knowledge over the course of the preceding 2 days. 2. Identify areas of knowledge gaps. 3. Explain principles of hemodynamics, left ventricular and right ventricular assessment. Page 2 of 7

3 4. Illustrate the principles and applications of tissue Doppler and Cardiac Kinetics. 5. Interpret the echocardiographic assessment of the atria, great vessels, artifacts, normal and abnormal variants and pericardial disease states. Tuesday, February 27 7:30 9 am Basic 3D Symposium Moderator: Massimiliano Meineri, MD 1. Outline the physics of three-dimensional (3D) echocardiography and the relationship to image creation and optimization. 2. Compare 3D and 2D modalities with respect to fundamental differences in image characteristics. 3. Develop and understanding of the advantages and limitations of imaging cardiac structures in both 2D and 3D. 9:30 11:30 am Aortic Valve Symposium Moderator: Mark Taylor, MD 1. Outline a strategy to perform a comprehensive echocardiographic aortic valve (AV) valve examination. 2. Demonstrate the utility of TEE in classification of difficult subgroups of aortic stenosis (AS) patients. 3. Discriminate the severity of stenotic and regurgitant lesions based on their Doppler patterns. 4. Identify the limitations of 2D, 3D and Doppler Evaluation of AV diseases. 11:30 am 12:15 pm Prosthetic Valve Symposium I Moderator: Fabio Papa, MD 1. Understand the principles of echocardiographic visualization and assessment of different prosthetic valves. 2. Understand how to perform hemodynamic assessment of normal prosthetic valves. 3. Recognize normal and abnormal echocardiographic findings in regards to prosthetic valve examination. 1:15 3:15 pm Mitral Valve Symposium Moderator: Annette Vegas, MDCB 1. Examine the mitral valve (MV) qualitatively and quantitatively with 2D and 3D imaging. 2. Illustrate the various criteria of establishing severity of regurgitation. 3. Interpret Doppler profiles to accurately classify various stages of mitral stenosis. Page 3 of 7

4 3:45 5:30 pm Tricuspid and Pulmonic Valve Symposium Moderator: Douglas Shook, MD 1. Identify various components of tricuspid valve (TV) anatomy. 2. Describe the various 2D and Doppler indices for grading the severity of tricuspid regurgitation (TR). 3. Relate the echocardiographic challenges associated with diagnosis and interpretation of functional tricuspid regurgitation (FTR). 4. Categorize the severity of tricuspid stenosis using 2D and Doppler indices. 5. Examine the pulmonic valve. 6:30 7:30 pm Day in Review Presenter: Andrew Maslow, MD 1. Assess their acquisition of knowledge over the course of the preceding 3 days. 2. Identify areas of knowledge gaps. 3. Describe the value of TEE for the intraoperative assessment of patients undergoing cardiac surgery. 4. Summarize the role of echocardiography in intraoperative hemodynamic evaluation. 5. Illustrate the limitations of TEE in echocardiographic assessment of cardiac pathology. 6. Outline 3D echocardiography fundamentals and applications. Wednesday, February 28 6:45 7:45 am Problem-Based Learning Discussions (PBLDs) Moderators: Alina Nicoara, MD and Kent Rehfeldt, MD At the conclusion of this activity, participants will be able to: Moderate Aortic Stenosis - 1. Describe how to define and grade moderate aortic stenosis utilizing 2D ultrasound and Doppler echocardiography. 2. Discuss the echocardiographic and surgical risk factors, which impact treatment decision-making perioperatively in patients with moderate aortic stenosis (AS). 3. Define low gradient AS and discuss the differences between severe AS and pseudo-stenosis. 4. Justify the utilization of dobutamine to help evaluate severity of aortic stenosis in low flow/low gradient stenosis. 5. Interpret the management of patients with moderate aortic stenosis in association with other cardiac surgical procedures utilizing current management guidelines. Moderate Mitral Regurgitation - 1. Describe the echocardiographic protocols for severity assessment of mitral regurgitation (MR). 2. Infer the effects of general anesthesia on the severity assessment of MR. Page 4 of 7

5 3. Relate the echocardiographic and surgical risk factors, which impact intraoperative decision-making in patients with moderate MR. 4. Justify the management of patients with moderate MR in association with other cardiac surgical procedures utilizing current management guidelines. Moderate Tricuspid Regurgitation - 1. Describe the echocardiographic grading of moderate TR. 2. Identify the reasons for underestimation of TR under general anesthesia 3. Outline the echocardiographic and surgical risk factors, which impact intraoperative decision-making in patients with moderate TR. 4. Explain the management of patients with moderate tricuspid regurgitation in association with other cardiac surgical procedures utilizing current management guidelines am You Are the Surgeon: Hands-On Porcine Heart Dissection Moderators: Douglas Shook, MD and Matt Maxwell, MD 1. Identify cardiac and great vessel anatomy in the porcine heart. 2. Illustrate porcine anatomical structures to echocardiographically understand 2D and 3D echocardiographic structures. 3. Demonstrate surgical anatomic landmarks through porcine anatomical structures. 4. Assess anatomical and echocardiographic findings with perioperative and surgical management strategies. 12:30 2:30 pm 3D Symposium II Moderator: Feroze Mahmood, MD 1. Define the approach to the appropriate use of intraoperative 3D echocardiography. 2. Describe how to apply the qualitative and quantitative 3D echocardiographic examination. 3. Illustrate the value of 3D echocardiography in surgical decision-making. 4. Compare and contrast the various 3D imaging platforms available to assess cardiac/valvular structure and function. 3 4 pm Congenital Symposium Moderator: Nikolaos Skubas, MD 1. Identify the most common cardiac congenital abnormalities. 2. Distinguish the differences between various atrial and ventricular septal defects. 3. Outline common cardiac congenital abnormalities that can remain undiagnosed and discovered incidentally in adult patients. 4. Categorize the cardiac congenital abnormalities that can impact the course of cardiopulmonary bypass. Page 5 of 7

6 4 5 pm Prosthetic Valve Symposium II Moderator: Madhav Swaminathan, MD 1. Describe the principles of echocardiographic visualization and assessment of different annuloplasty rings. 2. Summarize information which will help guide surgical decision making in regards to implantation of annuloplasty rings for common valve repair techniques. 3. Identify prosthetic valve dysfunction and guide surgical decision making. 4. Explain the utility of 2D and 3D TEE in the analysis of paravalvular leaks. 5 6 pm Day in Review Moderator: Feroze Mahmood, MD 1. Assess their acquisition of knowledge over the course of the preceding 5 days. 2. Identify areas of knowledge gaps. 3. Describe the value of TEE for the intraoperative assessment of patients undergoing cardiac surgery. 4. Summarize the role of echocardiography in advanced perioperative clinical decision making. 5. Outline echocardiographic applications for patients with structural heart disease undergoing a variety of procedures. Thursday, March 1 7:30 9:30 am Decision Making in Mitral Valve Surgery Moderator: Bruce Bollen, MD 1. Identify the mechanisms of MR, classification systems and utilization of 2D and 3D echocardiography for its quantification. 2. Recognize the rationale for utilizing a mitral annuloplasty technique during mitral valve repair and the basis for utilizing rings/bands and rationale for these being flexible vs semi-flexible vs rigid. 3. Illustrate the value of 3D and 3D imaging for repair of myxomatous (primary) mitral valve disease, the anatomic/echocardiographic risk factors for failure pre-repair and assessment of a repaired mitral valve. 4. Recognize the controversies concerning assessment of ischemic (secondary) mitral regurgitation (IMR), role of surgical intervention, and chosen therapeutic strategy. 5. Develop a multi-disciplinary approach to the complex cardiac patient. 6. Synthesize intraoperative imaging a collaborative multi-disciplinary decisionmaking process :30 am Decision Making in Aortic Valve Disease Moderator: Alina Nicoara, MD Page 6 of 7

7 1. Categorize AS severity in patients with low flow or low gradients scenarios. 2. Point out specific therapeutic options regarding concomitant aortic valve replacement during cardiac surgery. 3. Identify echocardiographic features suggestive of successful aortic valve repair. 4. Outline strategies for interrogating implanted aortic valve prosthesis when a high prosthetic pressure gradient is measured. 5. Develop new imaging techniques and their applications for aortic valve disease surgical decision making. 6. Develop a multi-disciplinary approach to the complex cardiac patient. 7. Synthesize echocardiographic imaging knowledge imaging into multidisciplinary decision-making. Noon 12:45 pm 11th Annual Arthur E. Weyman, MD, Lecture Moderator: Mark Taylor, MD and Feroze Mahmood, MD 1. Appraise the recent advances in cardiovascular echo imaging. 2. Review the role of echo imaging in the surgical, interventional or critical care environments. 3. Relate the contemporary challenges for perioperative echocardiographers. 1 2:30 pm Advanced Clinical Decision Making Mechanical Support Devices Moderator: Kent Rehfeldt, MD 1. Recognize the applications of echocardiography in patients with LV, RV and bi-ventricular (LVAD, RVAD and BIVAD) assist devices. 2. Demonstrate the echocardiographic assessment of patients on extracorporeal membrane oxygenation (ECMO) support. 3. Summarize echocardiographic assessment relevant for placement of ventricular assist devices and ECMO devices. 4. Recognize the value of imaging based multi-disciplinary approach to the complex cardiac patient. 5. Formulate strategies to incorporate information obtained from imaging into decision-making process. 3 5 pm The Heart Team: Structural Heart Disease Symposium I Moderator: G. Burkhard Mackensen, MD 1. Name the various structural heart disease interventions that require echocardiographic guidance. 2. Illustrate the role of TEE for specific structural heart disease interventions. 3. Show the various two and three-dimensional echocardiographic views for specific structural heart disease interventions. 4. Outline the conduct of the entire procedure with specific role of echocardiography. 5. Summarize the role of three-dimensional imaging during various structural heart disease interventions. 6. Outline a multi-disciplinary approach to the complex cardiac patient. 7. Synthesize imaging into the multi-disciplinary decision-making process. Page 7 of 7

8 5:15 8:15 pm 3D Imaging and Laptop Computer Workshop Moderator: Madhav Swaminathan, MD 1. Manipulate 3D datasets for clinical decision-making. 2. Recognize the utility of multi-planar analysis of 3D volume data sets. 3. Illustrate the limitations of 3D imaging for qualitative and quantitative analysis. 4. Use 3D for clinical decision making. Friday, March 2 7:30 9:30 am The Heart Team: Structural Heart Symposium II Moderator: Charles Nyman, MBBCh 1. Outline an echocardiographic approach to total endoscopic heart surgery. 2. Describe the immediate and follow-up evaluation of patients after percutaneous aortic valve replacement (TAVR). 3. Compare and contrast various percutaneous approaches to TV and the role of intraoperative imaging for procedural guidance. 4. Categorize the advantages and limitations of using TEE to guide complex mitral valve interventions using percutaneous approaches. 5. Appraise the value of a multi-disciplinary approach to the perioperative management approach to the complex cardiac patient. 6. Synthesize imaging into the multi-disciplinary decision-making process. 9:45 am 12:15 pm Echo Week Post Test: A Comprehensive Review of Echo Week Moderator: Feroze Mahmood, MD and Peter Panzica, MD 1. Assess the knowledge level of the attendees after the training course. 2. Identify areas of knowledge gaps regarding perioperative and peri-procedural echocardiography. 3. Modify their educational approach in light of the identified knowledge deficiencies. 4. Evaluate the value of the training course in comprehensively enhancing their perioperative echocardiographic knowledge. Page 8 of 7

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