Perioperative Hemodynamic Echocardiography
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Perioperative hemodynamic echocardiography (PHE) refers to the use of either the perioperative performance of transesophageal echocardiography (TEE) or transthoracic echocardiography (TTE) in addition to relevant Ultrasound scanning in patients undergoing non-cardiac surgery in order to provide an ongoing assessment of hemodynamic status. PHE assessment includes evaluation of ventricular loading conditions, bi-ventricular function, responses to therapeutic interventions, identification of RWMA, diagnosis of valvular lesions and dynamic ventricular outflow tract obstruction, unanticipated pulmonary embolism, pericardial effusion and assessment of cardiac output.
The Fellow will be exposed to a wide variety of cases including high-risk procedures and high-risk patients undergoing non-cardiac surgery. The PHE Fellow is responsible for examining the indications for the echo, preparation of the echocardiography machine and performing the echocardiography under supervision of a certified echocardiographer. The image quality and the interpretation of the findings will be discussed with the Fellow during performance of the exam. It is expected that the Fellow will produce an echo report at the end of the case. The report will be then reviewed by the supervisor and finalized.
The duration of the fellowship is 12 months.
Eligibility: Anesthesiologists with completed Anesthesia Fellowship training and certification.
To apply, please refer to the “Fellowship Application Instructions” link on the main Fellowships page.
Goals and Objectives
The aim of the program is to produce qualified echocardiographers with a main interest in utilizing echocardiography in non-cardiac surgery for optimal patient management with the following objectives:
- Acquire cognitive and technical skills in advanced-level perioperative transesophageal echocardiography(TEE) and transthoracic echocardiography (TTE).
- Develop proficiency in performing qualitative echocardiographic assessment of the hemodynamics.
- Acquire specialized expertise in the performance and interpretation of echocardiographic findings.
- Develop expertise in mastering hemodynamic management in high risk patients and in patients presenting for high risk surgery
- Understand the indications, contraindications, clinical applications and quality assurance of the perioperative hemodynamic echocardiography.
- Ability to perform quantitative echocardiographic exams at different settings (pre-op, intra-op and post-op) with the specific goal of attaining the National Board of Echocardiography's Certification in Perioperative echocardiography at completion of fellowship training.
- Provide leadership in perioperative echocardiography.
There are periodic formal evaluations of Fellow's progress at the end of each rotation. Each fellow keeps a log of all cases performed and reviewed during his/her training to assess the Fellow's exposure and knowledge. The case numbers is used to obtain the NBE Certification. The fellow is expected to be actively involved in a research project with national presentation at the Canadian Society of Anesthesiology Annual meeting.
Details of the PHE Fellowship Program
The Fellowship is of a 12-month duration, which allows enough exposure time to a wide variety of cases. The Fellow will be based at one of The Ottawa Hospital campuses. While the majority of the fellowship time will be spent at the main operating rooms, the Fellow will be assigned for one block to perform transthoracic echocardiography at the pre-anesthetic unit (PAU).
A total of three days per week will be considered as echo days while two days per week the Fellow is expected to work independently in the operating rooms.
Further details about the echo rotation will be provided to the Fellow during the interview.
Academic Activities
The Fellow is expected to be actively involved in a research project with an aim to present the work at the Canadian Society of Anesthesiology’s annual meeting.
Echocardiography CME and Echo Rounds
A series of echo lectures and discussions will be conducted on regular basis and will focus on:
- Physics and basics of the ultrasounds
- Hemodynamics (systolic and diastolic function)
- Valve lesions and impact on hemodynamics
- Cardiac hemodynamic measurement and Calculations
In addition, there are biweekly echo rounds presented by the echo Fellows.
Echo Simulator Training
The University of Ottawa Skills and Simulation Centre has an echo simulator with the ability to perform both TTE and TEE study. Echo probe with an adjustable scan plane can produce an echo view that is demonstrated in real time. Allocation of time for the Fellow to ensure enough exposure to simulator will be addressed. Full range of normal views is obtainable by the echo simulator, in addition to some pathology and clinical scenarios. Emerging data shows that the echo simulator is a very useful teaching tool for beginners.
Contact Us
Dr. Hesham Talab
PHE Fellowship Director
Tel: 613-798-5555 Ext. 13209
Fax: 613-761-5209
Email: Hesham Talab