Transoesophageal Echocardiography in Congenital Heart Disease

Details

Title

Transoesophageal Echocardiography in Congenital Heart Disease

Type

Stage Two

Module code

HPS147

Requirement

Optional

Module objective

By the end of this module the Clinical Scientist in HSST will be able to analyse, synthesise, critically evaluate and apply their knowledge of transoesophageal echocardiography (TOE), including three-dimensional imaging (3D), in patients with CHD. They will master the technique of TOE in paediatric and adult patients to acquire, analyse, display and interpret various cardiac structures.

The Clinical Scientist in HSST will be expected to apply their knowledge in their scientific and clinical practice while consistently demonstrating the attitudes and behaviours necessary for the role of a Consultant Clinical Scientist within a patient-focused service.

Knowledge and understanding

By the end of this module the Clinical Scientist in HSST will critically analyse, synthesise, evaluate and apply their expert knowledge, including:

• instrumentation and equipment;
• patient safety issues and probe safety issues;
• standards of probe cleaning technique and probe inspection;
• individual hospital policy and protocols regarding probe cleanliness and disinfection;
• how the different TOE probes work, including biplane and omniplane probes;
• TOE probes including neonatal, paediatric and adult probes;
• conventional standardised image planes to perform a comprehensive TOE examination;
• how to recognise normal anatomy, normal variants and pathological states;
• management and work flow for image storage;
• the indications and contraindications for TOE;
• the current and potential clinical applications of TOE;
• 2D TOE and its application to assessment of cardiac function and structure.

3D TOE in CHD:

• the indications and contraindications for 3D TOE;
• the unique and dynamic 3D spatial information that 3D TOE provides that cannot be obtained by 2D TOE or fluoroscopy;
• how to acquire good 3D datasets appropriate to the anatomy being interrogated;
• 3D normal anatomy, congenital heart anatomy and postoperative anatomy;
• the purpose of 3D LV volume rendering and function assessment and its advantages and limitations compared with other function assessment techniques;
• how to use live 3D imaging versus full volume datasets;
• the impact of 3D TOE on surgical decision making;
• technical and process advancements in cardiology and imaging research;
• the weight boundaries for 3D TOE probes.

TOE in CHD for catheter procedure guidance:

• which imaging planes are best for guiding particular procedures;
• the limitations of the guidance that can be offered to the interventionalist;
• the indications and contraindications for TOE in the catheter lab.

Technical and clinical skills

By the end of this module the Clinical Scientist in HSST will have a critical understanding of current evidence and its application to the full range of TOE in patients with CHD. They will be able to perform and master each technique, adapting their response to reliably meet the varying and complex challenges that will arise and will be able to:

• introduce a TOE probe safely in paediatric and adult patients;
• perform TOE using standardised conventional image planes and producing high- quality images across a range of patients, including:
  • neonates, paediatric patients and adults with CHD;
  • under general anaesthesia;
  • under intravenous and local sedation;
  • guide surgeons and interventionists with various anatomical repairs andclosures;
    • assess surgical results with intraoperative TOE
• perform TOE in CHD for catheter procedure guidance;
• use the various 3D display methods on the ultrasound machine;
• crop and display the 3D datasets anatomically ‘on-cart’ for rapid assessment;
• crop images off-line on reporting software;
• interpret the findings in relation to the anatomy, recognising normal anatomy, normal variants and pathological states.

TOEin CHD for catheter procedure guidance:

• guide diagnostic and interventional procedures across a range of paediatric and adult patients;
• take the appropriate pictures in the appropriate order and relay the findings immediately to the interventional team;
• adjust imaging as required by the interventionalists;
• interpret findings in relation to anatomy, recognising normal anatomy, normal variants and pathological states.

By the end of this module the Clinical Scientist in HSST will also be expected to critically reflect on their clinical practice. They will apply in practice a range of advanced clinical and communication skills to advise and communicate effectively with patients, relevant clinicians, patients and the public, and other healthcare professionals, and will be able to:

• use provided resources and make arrangements for interpreters and senior support where required;
• gain informed consent for each procedure appropriate to their role;
• accurately and concisely document findings, interpreting these to provide a clinical opinion;
• discuss and communicate the findings from TOE efficiently and effectively with team members, as well as other relevant health professionals.

Attitudes and behaviours

By the end of this module the Clinical Scientist in HSST will be expected to critically evaluate their own response to both normal and complex situations. They will consistently demonstrate the professional attributes and insights required of a Clinical Scientist in HSST working within the limits of professional competence, referring as appropriate to senior staff, and will:

• take a leadership role in the organisation and administration of cardiac imaging and 3D reconstruction services, leading training and clinical supervision;
• collaborate with specialists in other imaging modalities;
• evaluate each session and develop action plans to improve teaching;
• work collaboratively with cardiologists, cardiac surgeons, other medical staff, healthcare science practitioners, other echocardiographers and nurses;
• be decisive and concisely communicate findings to the team;
• lead training and clinical supervision in the catheter lab;
• work collaboratively with cardiologists, cardiac surgeons and other medical staff to support procedural success.