ASE's Comprehensive Echocardiography !!BETTER!!
Senior editors Roberto Lang, MD, FASE; Steven Goldstein, MD; Itzhak Kronzon, MD, FASE; Bijoy K. Khandheria, MD, FASE; Muhamed Saric, MD, PhD, FASE, FACC; and Victor Mor-Avi, PhD, FASE, designed this 3rd Edition to cover numerous advances in this rapidly evolving field including critical care echocardiography, cardio-oncology, structural heart disease, interventional/intraoperative echocardiography, strain, and 3D imaging. You will not only receive the hard-bound book with over 1,000 pages, but also online access that allows you to easily browse, search, and download content as well as view over 1,200 images and 580 videos.
ASE's Comprehensive Echocardiography
Covers recent advances in critical care echocardiography, cardio-oncology, structural heart disease, interventional/intraoperative echocardiography, strain imaging of left and right heart chambers, multimodality imaging in systemic diseases, and novel 3D techniques.
Written and endorsed by world experts from the American Society of Echocardiography (ASE), this unique multimedia resource uses text, case studies, and online components to cover the latest uses of echocardiography, including the most recent 2D and 3D advances. Unlike other existing textbooks in echocardiography, including the predecessor of this volume, entitled Dynamic Echocardiography, this 2nd edition, with its new title, covers a full range of topics, reflected in its 200 chapters that include essential material in a succinct format. Dr. Roberto M. Lang and his expert colleagues provide everything you need to assess cardiac anatomy and function and obtain clinically useful, noninvasive information for more accurate diagnosis and evaluation of heart disease.
Stay up to date with hot topics in this rapidly evolving field: interventional/intraoperative echocardiography, transesophageal echocardiography, cardiac resynchronization therapy, and more.
2019 ACC/AHA/ASE Advanced Training statement on echocardiography (Revision of the 2003 ACC/AHA Clinical Competence Statement on Echocardiography) : a report of the ACC competency management committee. / ACC Competency Management Committee.
ASE is committed to the health, safety and wellbeing of our members and the patients we serve. This document is provided to the ASE community as a service to help guide the practice of echocardiography in this challenging time. It represents input from a variety of echocardiography practitioners and institutions who have experience with the COVID-19, or have been actively and thoughtfully preparing for it. The circumstances surrounding the outbreak are, of course, extremely dynamic, and this statement's recommendations are subject to change. We direct echocardiography practitioners to the Centers for Disease Control (CDC) website for the latest updates and recommendations.
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.
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.
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.
Although transesophageal ultrasound was first reported in the 1970s, the advent of phased array transducers and flexible transesophageal probes in the early 1980s enabled improved visualization of cardiac structures. Transesophageal echocardiography has become a commonly used imaging modality in a wide range of settings including the cardiac operating theatre, the intensive care unit, the interventional laboratory, as an outpatient procedure, and as a monitoring or rescue device in patients who have or are expected to have unexplained cardiovascular instability. Recently, the development and widespread availability of real-time 3-dimensional echocardiography has expanded the role of TEE in the guidance of complicated cardiac surgical procedures and catheter-based cardiac interventions such as transcatheter aortic valve replacements (TAVR).
Although transesophageal ultrasound was first reported in the 1970s, the advent of phased array transducers and flexible transesophageal probes in the early 1980s enabled improved visualization of cardiac structures. Transesophageal echocardiography (TEE) has become a commonly used imaging modality in a wide range of settings including the cardiac operating theatre, the intensive care unit, the interventional suit, as an outpatient procedure, and as a monitoring or rescue device in patients who have or are expected to have unexplained cardiovascular instability. TEE is able to provide excellent ultrasonic imaging compared to transthoracic echocardiography (TTE) because of the proximal location of the esophagus next to the heart and great vessels, and avoidance of the lungs and ribs as impediments to imaging. In addition, TEE is more practical than TTE during most surgeries and especially during cardiac surgical operations because of the need to avoid the sterile operating field. For these reasons, TEE is superior to TEE during cardiac surgery, for certain diagnosis, and for many catheter-based cardiovascular interventions. Recently, the development and widespread availability of real-time 3-dimensional echocardiography has expanded the role of TEE in the guidance of complicated cardiac surgical procedures and catheter-based cardiac interventions such as transcatheter aortic valve replacements (TAVR).
The Society of Cardiovascular Anesthesiologists (SCA) and the American Society of Echocardiography (ASE) published a first set of guidelines for the performance of a comprehensive intraoperative TEE exam in 1999. The aim of these guidelines was to define a standard examination for the purposes of training, consistency, storage, and quality. These guidelines contain a set of twenty TEE views that were primarily designed for intraoperative use although they have been widely adopted outside of the operating room. These guidelines were updated in 2013 to now include an expanded 28 standard views as well as 3-dimensional imaging. In addition, a set of basic perioperative TEE guidelines were also published in 2013 that included 11 standard views. The SCA and the ASE realized that the availability and use of TEE as a monitoring and diagnostic rescue tool outside of cardiac surgery had dramatically increased. Therefore, a basic set of guidelines that were intended for use in general operating rooms by non-cardiac anesthesiologists were developed.
The transesophageal echocardiography (TEE) probe is inserted through the oropharynx into the esophagus. All of the described TEE views are obtained when the TEE probe is located in the esophagus or stomach. The echocardiographer is typically able to identify a variety of structures including the cardiac chambers, valves, lungs, liver, superior vena cava, inferior vena cava, hepatic vein, pulmonary veins, pulmonary arteries, aorta, and stomach. One limitation of TEE is that the left main bronchus disrupts the views of the aortic arch and proximal ascending aorta.
There are multiple clinical indications for TEE. It typically provides superior imaging versus transthoracic echocardiography. It is an invasive test, however, and its use in patients should be warranted. Indications for TEE include:
Transesophageal echocardiography (TEE) is considered to be a relatively safe procedure when performed by a trained physician. There is disagreement in the literature and among experts in the field about the presence of absolute and relative contraindications to the use of transesophageal echocardiography. However, many practitioners agree that the following conditions are
According to the 2010 American Society of Anesthesiologists and Society of Cardiovascular Anesthesiologists Practice Guidelines for Perioperative Transesophageal Echocardiography, TEE may be utilized in patients with oral, esophageal, or gastric conditions if the expected benefit is greater than the potential risk and if the necessary precautions are followed. These include limiting the exam or its duration, the avoidance of unnecessary probe manipulations, having the exam performed by the most experienced echocardiographer, acquiring a gastroenterology consult, and the consideration of other imaging options such as TTE or epicardial echocardiography.
Knowledge and understanding of ultrasound physics and familiarity with the echocardiography machine and its controls are paramount to obtain useful TEE imaging, decrease artifacts, and to prevent misdiagnosis. Equipment required for a transesophageal echocardiography exam includes both an echocardiography machine and an appropriate transducer, as well as a method to archive and store, completed examinations. The multiplane (meaning that its imaging angle can be adjusted from zero to one-hundred eighty degrees) TEE probe has a connector that can be attached to the ultrasound machine, 2 dials that control side-to-side and forward and backward movement of the tip, and an ultrasonic transducer at the end. The transducer contains ceramic lead zirconate titanate and consists of a phased array of piezoelectric crystals which both send and receive ultrasound waves. The transducer and probe may be 2-dimensional or 3-dimensional and contain a dramatically increased number of crystals. During an exam, the transducer will lie in contact with the esophagus or stomach and generate sound waves which will be attenuated, refracted, scattered, or reflected back from certain cardiac structures. In echocardiography, ultrasound with frequencies of 2 to 10 MHz is utilized. This is significantly higher than sound in the audible range (the upper limit of which is approximately 20,000 Hz). The piezoelectric crystals will then convert the reflected sound into electric pulses which allow the creation of an image of the heart or other structure on display. 041b061a72