Liverpool Hospital
Cardiac anaesthesia Ultrasound
Fellowship
Components
 “HART” scan
 PGCertCU or PGDipCU
 Bedside teaching
 Echo Lab Attachment
Objective
Attain to a substantial standard basic peri operative echocardiography as outlined by the
ACC/AHA Clinical Competence on Echocardiography Statement. This comprises of basic
skills, peri operative cognitive skills and technical skills.
It is anticipated that, at the end of the cardiovascular module, the fellow is competent with
making a peri operative diagnosis of myocardial ischemia and infarction, the peri operative
assessment of hemodynamics and ventricular function, and the peri operative diagnosis and
management of cardiovascular collapse.
Basic Skills
● Knowledge of physical principles of echocardiographic image formation and blood flow
velocity measurements.
● Knowledge of instrument settings required to obtain an optimal image.
● Knowledge of normal cardiac anatomy.
● Knowledge of fluid dynamics of normal blood flow.
● Knowledge of pathological changes in blood flow due to acquired heart disease.
Peri operative Cognitive Skills
● Knowledge of the equipment handling, infection control, and electrical safety
recommendations associated with the use of TTE/TOE.
● Knowledge of the indications and the absolute and relative contraindications to the use of
TTE/TOE.
● General knowledge of appropriate alternative diagnostic modalities.
● Knowledge of the normal cardiovascular anatomy as visualized by TTE/TOE.
● Knowledge of commonly encountered blood flow velocity profiles as measured by
Doppler echocardiography.
● Detailed knowledge of the echocardiographic presentations of myocardial ischemia and
infarction.
● Detailed knowledge of the echocardiographic presentations of normal and abnormal
ventricular function.
● Detailed knowledge of the physiology and TTE/TOE presentation of air embolization.
● Knowledge of native valvular anatomy and function, as displayed by TTE/TOE.
● Knowledge of the major TTE/TOE manifestations of valve lesions and of the TTE/TOE
techniques available for assessing lesion severity.
● Knowledge of the principal TTE/TOE manifestations of cardiac masses, thrombi, and
emboli; cardiomyopathies; pericardial effusions and lesions of the great vessels.
Peri operative Technical Skills
● Ability to operate the ultrasound machine, including controls affecting the quality of the
displayed data.
● Ability to perform a basic cardiac echo examination.
● Ability to recognize major echocardiographic changes associated with myocardial ischemia
and infarction.
● Ability to detect qualitative changes in ventricular function and hemodynamic status.
● Ability to recognize echocardiographic manifestations of air embolization.
● Ability to visualize cardiac valves in multiple views and recognize gross valvular lesions and
dysfunction.
● Ability to recognize large intracardiac masses and thrombi.
● Ability to detect large pericardial effusions.
● Ability to recognize common artifacts and pitfalls in TEE examinations.
● Ability to communicate the results of a TTE/TOE examination to patients and other health
care professionals and to summarize these results cogently in the medical record.
Syllabus
Physical principles of US:
Sound source, Frequency, Wavelength and tissue propagation velocity
Amplitude, Power and Intensity,
Beam characteristics: The Duty factor, The Spatial Pulse Length, Pulse
repetition frequency, Pulse repetition period, Frame Rate
Attenuation, Absorption, Reflection, Refraction, Scattering, Resolution
Transducer types and selection
Principles of Doppler US
US modes: A mode, B mode, M mode, 2D, Doppler, colour Doppler, Colour M
mode, tissue Doppler, 3D
Image processing: Gain, compression, TGC, digital processing
Knobology
Anatomy and physiology of the heart
Measurements and calculations
Cardiac dimensions, pressure gradients, FS, FAC, EF, SV, CO, PISA, ERO, PHT,
shunt fraction
Indications, contraindications, limitations, and safety of TTE and TOE
Comparison of cardiac US and other imaging modalities.
Image planes and standard views of TTE and TOE
Use of cardiac US to evaluate:
Artefacts, pitfalls and masses
Anatomy and Systolic LV function:
Global and RWMA, complications of IHD, cardiomyopathies
Diastolic LV function
Anatomy and RV function
Valvular function:
MV anatomy, MR and MS
AV anatomy, AR and AS
TV and PV anatomy and function
Prosthetic valves recognition and dysfunction
Pericardial disease:
Effusion, tamponade, constrictive pericarditis
Aorta: Anatomy, atheroma, dissection
Haemodynamic status assessment:
Hypovolaemia, sepsis, heart failure
Pulmonary disease:
Pleural effusion
Adult congenital heart disease
Requirements
Committed involvement of the participating registrar.
Once a week attendance to the Echo Lab.
Log Book of all the performed and reported cases. Xnumber of reported cases reviewed by
and experience echocardiologist.
 Completion of 50 Studies and documentation with a logbook
References
Outline of Core Curriculum in Echocardiography American Society of Echocardiography
ACC/AHA Clinical Competence Statement on Echocardiography 2003