THIRD TORONTO PERIOPERATIVE 3D TEE COURSE – Hands On!

Friday, November 4th, 2022
Sunnybrook Health Science Centre, Michael Julius Atrium (M6 400)
2075 Bayview Avenue, Room M3 400, Toronto, ON, M4N 3M5

Sophia Wong

Registration – Coming Soon!

Course Director: Dr. Jacobo Moreno
CME Planning Committee: Sarah Russell, Azad Mashari, Elmari Neethling, Pablo Perez d’Empair, Sophia Wong, Yannis Amador

Course Objectives

With improvements in the underlying technology and usability, 3D TEE is becoming increasingly integrated into the perioperative evaluation of patients undergoing cardiac and other complex surgical and minimally invasive procedures.

After active participation in this one-day course participants will be able to

  1. Explain the basic process of 3D TEE image acquisition and its associated limitations and pitfalls as they relate to common clinical scenarios
  2. Describe and demonstrate the step-by-step process of 3D TEE image acquisition and optimization for perioperative assessment of cardiac chambers and valves.
  3. Describe and demonstrate basic manipulation of 3D data-sets for a structures qualitative evaluation of key structures. 
  4. Demonstrate the quantitative analysis of 3D data-sets of key cardiac structures and describe the indications and clinical relevance of 3D quantification in common clinical situations.
 

Program & Session Objectives

7:30 Registration & Breakfast

7:50 Introduction to Course and Faculty – Jacobo Moreno

Introduction to 3D TEE – Moderator Elmari Neethling

8:00 Anatomy for 3D echocardiography – Azad Mashari

  • Describe the structure and orientation of the heart base in relation to standard TEE imaging windows
  • Identify clinically relevant structures and orientation in standard 3D TEE views
  • Be able to adjust probe position to optimize 3D view without going back to 2D images

8:20 Introduction to 3D TEE – Wendy Tsang

  • Discuss the clinical utility of 3D Echocardiography technology.
  • Explain basic principles of 3D echo imaging with modern matrix array transducers
  • Describe the main 3D acquisition modes and compare and contrast their clinically relevant features and use cases (Live/Birds view vs 3D Zoom/Medium volume vs Full Volume/Large volume)

8:40 3D TEE image optimization – Jacobo Moreno

  • Describe the basic function of key parameters for optimizing image acquisition: Sector Size, Depth, Gain, Focus, Line Density, Frequency, Gating, Resolution, Frame Rate.
  • Describe the basic function of key parameters for optimizing 3D image rendering (post processing): brightness, chrome maps, smoothing
  • Explain the diagnostic limitations, common artifacts and their mitigation strategies in 3D TEE.

9:00 Q&A

9:05 Refreshment break (10 min)

3D Acquisition: Theory & Hands-on – Moderator Pablo Perez d’Empair

9:15 3D Acquisition: Left and Right Ventricle – Ben Walker

  • Describe indications for 3D imaging of the right and left ventricles.
  • Explain how to obtain 3D images of the right and left ventricles.
  • Discuss the limitation of 3D vs 2D imaging of the ventricles.

9:35 3D Acquisition: Mitral Valve – Wendy Tsang

  • Describe the indications for 3D imaging of the mitral valve.
  • Explain the steps involved in acquiring and optimizing 3D images of the mitral valve
  • Describe the qualitative and quantiative examination of 3D MV image:
    • 3D views for qualitative assessment
    • Cropping techniques
    • Quantitative assessment
    • Multi-Plain Reformating

9:55 3D Acquisition: Aortic Valve – Yannis Amador

  • Describe the indications for 3D imaging of the aortic valve.
  • Explain the steps involved in acquiring and optimizing 3D images of the aortic valve
  • Describe the qualitative and quantiative examination of 3D AV image:
    • 3D views for qualitative assessment
    • Cropping techniques
    • Quantitative assessment
    • Multi-Plain Reformating

10:15 3D Acquisition: Tricuspid Valve – Sankalp Sehgal

  • Describe the indications for 3D imaging of the tricuspid valve.
  • Explain the steps involved in acquiring and optimizing 3D images of the tricuspid valve
  • Describe the qualitative and quantiative examination of 3D TV image:
    • 3D views for qualitative assessment
    • Cropping techniques
    • Quantitative assessment
    • Multi-Plain Reformating

10:35 Q&A

10:40 Refreshent Break (10 min)

10:50 Hands-on acquisition

  • Demonstrate the step-by-step acqusition and optimization of 3D views of  left and right ventricles, mitral valve, tricuspid valve and aortic valve

12:20 Lunch Break (45 min)

  • Replenish the vast amount of energy spent on the intensive learning experience of the previous 4.5 hours.

3D Clinical applications – Moderator Sophia Wong

13:05 3D TEE Clinical applications: Left and Right Ventricle– Ben Walker

  • Review the importance of 3D echocardiography in the assessment of left and right ventricle during cardiac surgeries.
  • Understand the importance of the use of 3D for these procedures.

13:25 3D TEE Clinical applications: Mitral Valve – Ahmad Omran

  • Review the importance of 3D echocardiography in the assessment of mitral valve surgeries.
  • Understand the importance of the use of 3D for these procedures.

13:45 3D TEE Clinical applications: Aortic Valve – Yannis Amador

  • Review the importance of 3D echocardiography in the assessment of aortic valve surgeries.
  • Understand the importance of the use of 3D for these procedures.

14:05 3D TEE Clinical applications: Tricuspid Valve – Sankalp Sehgal

  • Review the importance of 3D echocardiography in the assessment of tricuspid valve surgeries.
  • Understand the importance of the use of 3D for these procedures.

14:25 Q&A

14:30 Refreshment Break (10 min)

14:40 3D TEE Clinical applications: Paravalvular Leaks – Ahmad Omran

  • Review the importance of 3D echocardiography in the assessment of paravalvular leaks after valve surgery.
  • Understand the importance of the use of 3D for the assessment of paravalvular leaks, including localization and quantification.

15:00 3D TEE Clinical applications Mitral Clip/LAA Closure – Edgar Hockmann

  • Review the importance of 3D echocardiography in the assessment of the LAA and MV during this surgery.
  • Understand the importance of the use of live 3D to guide and help during this surgeries .

15:20 Q&A

15: 25 Break (10 min)

Computer analysis hands-on – Moderators Jacobo Moreno & Yannis Amador

15:35 Phillips Station: Philips QLAB – Yannis Amador

  1. Review the importance of 3D images postprocessing analysis.
  2. Perform basic 3D measurements as areas and distances, semiquantitative calculation of 3D ejection fraction of the left ventricle, and 3D valve quantification.

16:35 Refreshment Break (10 minutes)

16:45 GE Station: GE EchoPAC – Jacobo Moreno

  1. Review the importance of 3D images postprocessing analysis.
  2. Perform basic 3D measurements as areas and distances, semiquantitative calculation of 3D ejection fraction of the left and right ventricle, and 3D valve quantification.

17:45 Summary & Concluding remarks – Jacobo Moreno

18:00 Adjournment – Jacobo Moreno

Competing Interests Policy

Faculty will declare all relevant relationships and potential competing interests during their presentation.

Faculty COI statements will be posted here when available.

Should a conflict of interest be identified a variety of strategies will be employed for mitigation, as recommended by the Royal College of Physicians and Surgeons of Canada (https://www.royalcollege.ca/rcsite/cpd/accreditation/toolkit/faqs-on-accreditation-e ). These include revision of the presentation topic or focus; peer review of the content in question to ensure scientific integrity and balance. If the concern raised is not addressed by these methods, an alternate speaker for the topic will be sought out, or the topic removed from the program.