Subject(s)
Aortic Valve Insufficiency/etiology , Cardiac Valve Annuloplasty/adverse effects , Mitral Valve Insufficiency/surgery , Tricuspid Valve Insufficiency/surgery , Aged , Aortic Valve Insufficiency/surgery , Echocardiography, Transesophageal , Heart Valve Prosthesis Implantation , Humans , Male , Mitral Valve/surgery , Sutures/adverse effects , Treatment Outcome , Tricuspid Valve/surgeryABSTRACT
In this case report we describe a situation where despite a normal TEE exam immediately postcardiopulmonary bypass, there was no flow in the left internal mammary artery graft to the left anterior descending artery. This was picked up by coronary Doppler and subsequently repaired.
Subject(s)
Coronary Artery Bypass , Echocardiography, Doppler , Echocardiography, Transesophageal , Graft Occlusion, Vascular/diagnostic imaging , Internal Mammary-Coronary Artery Anastomosis , Intraoperative Complications/diagnostic imaging , Myocardial Infarction/surgery , Veins/transplantation , Cardiopulmonary Bypass , Graft Occlusion, Vascular/surgery , Humans , Intraoperative Complications/surgery , Male , Reoperation , Sensitivity and Specificity , SuturesABSTRACT
PURPOSE: Establish an expert consensus for training in perioperative echocardiography in the province of Quebec. METHODS: Cardiac anesthesiologists practicing in the province of Quebec with expertise in echocardiography were involved in the development of a multicentre expert consensus on training in perioperative echocardiography. Guidelines for training in adult echocardiography, transesophageal echocardiography and perioperative echocardiography by the American Society of Echocardiography (ASE), the American College of Cardiology (ACC) and/or the Society of Cardiovascular Anesthesiologists (SCA) were reviewed. RESULTS: A basic, advanced and director level of expertise were identified for training in perioperative echocardiography. The total number of echocardiographic examinations to achieve each of these levels of expertise remains unchanged from the 2002 ASE-SCA guidelines. However, the recommended proportion of examinations performed personally is increased in the Quebec expert consensus for both the basic and the advanced level of training to ensure proficiency in echocardiography while providing anesthesia care to the patient. A level of autonomy in perioperative echocardiography is also identified in the basic level of training as defined in the Quebec expert consensus. Maintenance of competence, certification in the perioperative transesophageal echocardiography (PTE) examination and duration of training are outlined for each of the three levels of training in the Quebec expert consensus but are not part of the recent 2002 ASE-SCA guidelines. CONCLUSION: Adequate perioperative echocardiographic training is an important aspect of cardiovascular anesthesia. The ACC, ASE and SCA guidelines for training in echocardiography were modified to reflect the expert consensus of anesthesiologists in the province of Quebec.
