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Kathirvel Subramaniam, MD, MPH, FASE
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Michael L. Boisen, MD, FASE
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The UPMC Department of Anesthesiology and Perioperative Medicine provides a comprehensive perioperative clinical echocardiography service and supports a very active echocardiography education program for trainees.
Transesophageal Echocardiography
Clinical services include diagnostic intraoperative transesophageal echocardiography (TEE) for all cardiac surgical patients, diagnostic intraoperative and postoperative TEE for non-cardiac surgical patients in situations of hemodynamic instability, and intraoperative TEE monitoring for patients at risk for perioperative cardiac complications undergoing high-risk non-cardiac surgical procedures. In fiscal year 2019, the service faculty performed about 2,205 comprehensive echocardiographic studies for cardiac and non-cardiac surgery. Our department has 16 cardiac anesthesiology faculty certified in perioperative advanced TEE.
Transthoracic Echocardiography
Our department also has trained expert faculty who can perform comprehensive and limited transthoracic echocardiography (TTE) for preoperative cardiac evaluation and focused cardiac ultrasound for diagnosing the etiology of hemodynamic instability and hypoxemia during the perioperative period for cardiac and non-cardiac surgical patients. A perioperative TTE consult service was established in 2016 and receives requests to perform TTE from anesthesia colleagues, hospitalists, and surgeons. TTE performed at the bedside by anesthesiologists helps to guide perioperative hemodynamic management, avoids unnecessary delays and cancellations in the operating room schedule, and improves patient outcomes.
TEE Education
All adult cardiothoracic anesthesiology fellows (four every year) fulfill 300 TEE examination requirements during their fellowship training to qualify for National Board of Echocardiography (NBE) advanced certification in perioperative TEE. Fellows receive training in advanced echocardiographic modalities such as 3D echocardiography, tissue Doppler, and myocardial deformation imaging. The UPMC Anesthesiology Residency Program has created a unique structured two-month elective rotation in basic TEE for PGY-4 residents to prepare them for basic NBE TEE certification. Our UPMC training program maintains a 100% passing rate in NBE TEE examinations and many residents go on to obtain basic TEE certification. Our TEE training program involves a TEE simulation course at WISER, web-based education modules, clinical training in the operating room, and weekly TEE reviews in the digital echocardiography laboratory by certified faculty. Our faculty also actively participate in interdepartmental echocardiography conferences along with Cardiology, Emergency Medicine, and Critical Care Medicine and organize several workshops for trainees and faculty.
Focused TTE education
PGY-2 residents also receive intensive training in structured focused transthoracic ultrasound during their post anesthesia care unit (PACU) rotation, completing 25 TTE examinations during their PACU rotation. Residents continue to utilize their focused TTE skills throughout their training for their elective and emergency cases. Focused TTE education is also facilitated by web-based education modules, a WISER simulation course on a TTE simulator and healthy volunteers, and several lectures related to focused TTE.
Digital Echocardiography Laboratory
A digital echocardiography laboratory is utilized for archiving all echocardiographic studies as part of a quality improvement program, allowing the education of residents and fellows in research studies related to echocardiography.