Scientific Debate Toe education in UK Sean Bennett

Sean Bennett is a consultant cardiothoracic anaesthetist at the Castle Hill Clinic in Hull, UK. He has been running practical training courses in TOE for years. Email:

I will like to keep EACTA informed of the progress towards UK accreditation in TOE training. The syllabus is in line with the EACTA TOE training course, in that some TTE is included. Under the auspices of the BSE (British Society of Echocardiography) we have made the following the components of TOE training. During an 24 month period the candidate must: keep a log-book of 125 cases No transthoracic cases to be included in the number of cases A case mix is recommended, but the number of various cases has been relaxed to allow for institutional variation. keep a video/disc log of 10 cases which may be called upon by the examiners. take a written examination of 100 MCQ (including video/disc cases) The candidate must have a BSE approved supervisor who oversees his/her work. The supervisor will be a BSE member (cardiologist or anaesthetist) who has a documented prior standard in TOE and who still actively performs TOE. The first (pilot) examination will be on October 30th 2003 in Birmingham at the start of the annual BSE conference. Written details from; BSE Administration, 9 Fitzroy Square London, W1T 5HW, e-mail: Web: » www.bcs.com/affiliates/bse.html » www.acta.org.uk/Training_TOE.asp Case report by Sean Bennett A 45 year old man presented with; fatigue, shortness of breath and pyrexia. He admitted to having had a murmur since childhood but that it was ‘nothing to worry about’. His transthoracic echo (TTE) suggested a right atrial mass. He then had a TOE performed which was reviewed and gave a differential diagnosis of ; atrial myxoma/thrombus, tricuspid endocarditis (but no history of substance abuse) and ruptured sinus of Valsalva. Finally the patient went to the operating room after failure to improve medically. The TOE was repeated after induction and reveals the diagnosis. Answer now to gain marks. No mar for ‘endocarditis’ without more detail! Standard teaching is that TTE is the appropriate investigation for ventricular septal defects and that TOE only adds information about valvular function. However some authors would disagree (1). Fig 1 Fig 2 In Figure 1 the TOE frame shows a mass in the region of the septal tricuspid leaflet. Even when the image is moving it is hard to be sure if this is originating from the valve itself or is indeed an atrial mass protruding into the right ventricle. This is not the right view for a ruptured sinus of Valsalva. Thus given the history a the mass seems likely to be a vegetation. But where from? Figure 2 reveals a sub-aortic jet, into the right ventricle. This is therefore a congenital membranous ventricular septal defect which has become the sight of infection. Surgery confirmed this, removed the vegetation and closed the hole. The patient made a full recover with an intact tricuspid valve.

Deadline for submitting abstracts for EACTA 2012 extended until 22nd January 2012

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18th National Congress of the Cardiovascular and Thoracic Anesthesia and Intensive Care Society
12-15th April 2012
Bodrum Turkey
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October 2011

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15th Annual Comprehensive Review & Update on Perioperative Echo
February 6 - 11, 2012
San Diego, CA
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17th Annual Update on Cardiopulmonary Bypass
March 11 - 16, 2012
Aspen/Snowmass Village, CO
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Thoracic Anesthesia Symposium
April 27 - 28, 2012
Boston, MA
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34th Annual Meeting & Workshops
April 28 - May 2, 2012
Boston, MA
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Cardiothoracic Symposium
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March 19th-21st 2012
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Abstracts from EACTA 2011
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2012 Combined Meeting of the 13th International Congress of Cardiothoracic and Vascular Anaesthesia and the New Zealand Anaesthesia Annual Scientific Meeting, to be held 14 - 17 November 2012, Auckland, New Zealand.
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EACTA Perioperative Echocardiography DVDs now available
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JCVA



The Journal of Cardiothoracic and Vascular Anesthesia (JCVA) is now the official journal of the European Association of Cardiothoracic Anesthesiologists (EACTA)......
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ACTA Autumn Meeting
Holywell Park
Loughborough, Leicestershire
16th - 18th November 2011
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