If You Don't Look, You Don't Know! - Echocardiography and Perioperative Ultrasound

Welcome to our incredible online lecture series, we’re stoked to have you! Our team is passionate about sharing our enthusiasm for perioperative ultrasound with students at every level around the world. There are already enough barriers to implementing these techniques, so we provide our content completely free of charge. BUT!! We need to justify the upkeep of this site to our institution. If you value this content please let me know, just a quick note from each of you (to joshua.zimmerman@hsc.utah.edu) will help! You can also sign up for my free clip of the day and register to attend our weekly live echo webinars. Cheers!

A Sampling of Recent Live Lectures!

Despite having an incredible archive of lectures (below), we continue to provide weekly live talks to our trainees. Starting with the 2023 lecture series we began offering these lectures on Zoom to a worldwide audience. It’s much more fun and much more engaging to attend the live lectures, but if you cannot, I’ll archive some of our recent live talks.

Full Echo Lecture Series

The links below are to our “Basics of Perioperative Echocardiography” lectures. These talks have been created by the University of Utah Department of Anesthesiology’s team of expert echocardiographers. Some of these lectures were recorded live and some were recorded in our studio. We begin with basic normal imaging, move on to assessment of ventricular and valvular function, and end with more advanced topics. The movies should play on your desktop, iPad, or iPhone. To reinforce the content of each lecture there will be image-based clip quizzes on our quiz site. Please send your feedback, suggestions, or comments to me at joshua.zimmerman@hsc.utah.edu. Enjoy!

Hocus PoCUS? Yep, it’s definitely magic!

OK, before we get on with the lecture series I just wanted to double check that you’re on the right page. The content below is our TEE-heavy resident lecture series. It forms the core of our TEE curriculum and while it does contain a number of non-TEE lectures if you’re looking for that content I suggest you follow this PoCUS link. This is a growing series of lectures designed to introduce concepts of focused cardiac ultrasound (FoCUS) and non-TEE point-of-care ultrasound (PoCUS) in general. If you’re taking one of our FoCUS workshops, this is the content you’ll need to review prior to arriving. Check back frequently as this content is growing rapidly!

Introduction to the Lecture Series

This is the so called “Echo Pep Rally!” and represents the introduction to our department’s new year of echo festivities. Not a content heavy lecture, but you’re still welcome to watch it.

Cardiac Anatomy for the New Echocardiographer

We all know lots of cardiac anatomy, but there is always more to learn. Before you begin the journey that will lead you to echocardiographic excellence, take a few minutes to review the basics of cardiac anatomy.

TEE – The Good, the Bad, and the Ugly

Got your attention? This talk will give an overview of indications, contraindications, and complications of TEE as well as tips on probe placement in the awake and anesthetized patient.

You Put the Probe Where?! TEE Safety

If you think this topic is boring, think again! Watch this talk from Dr. Gnadinger and avoid the dreaded ‘echo probe winds up in the surgical field’ syndrome. This is a more detailed discussion of the risks of TEE as well as a discussion of probe cleaning and maintenance. Important stuff!

Basic TEE

This covers what we’ll call the “University of Utah Basic TEE Exam”, which is a focused perioperative evaluation designed to answer basic questions about valvular function, ventricular function, and to identify causes of hemodynamic instability. This is nice introduction to normal TEE anatomy and includes both a live recording and a studio version. (Test your knowledge here!)

Basic TEE Exam Sheet

This is a link to our basic TEE exam sheet. Feel free to print this out and share it with your friends and colleagues!

Comprehensive TEE Exam

This lecture will review the views from the ASE’s guideline on performing a comprehensive TEE that are not included in the basic exam. Some of these will certainly come up in later lectures and in your clinical practice (and some may not, and there are some that they didn’t include that I wish they had. Oh well!)

Basic TTE – Why

Here we will discuss the value of transthoracic echo in the hands of perioperative physicians in a case-based review. This is one of my favorite talks, and it can be considered another, TTE-focused pep rally.

Basic TTE – How

This talk serves as a review of the basic transthoracic images (both performance and interpretation) that are most important to the perioperative physician. Another set of both live and studio versions. (Test your knowledge here!)

How-To TTE Live Version

OK, this is a preliminary version but I’m excited about the possibilities here! What you’ll see is me performing and describing a limited TTE exam in real time, with a screen showing probe position on the patient as well as the live image.

Basic Doppler Ultrasound

Dr. Jen Decou provides an excellent introduction to Doppler ultrasound concepts. This is not a comprehensive review of ultrasound physics (that comes later) but rather a basic nuts and bolts overview. (Test your knowledge here!)

Lung Ultrasound

This page includes an ever-expanding group of lectures (currently 5) on perioperative lung ultrasound. There is an awesome review of lung ultrasound for the anesthesiologist from Dr. Borgmeier’s perspective of fellowship training in both ultrasound and perioperative medicine. This is followed by a two-part discussion by Dr. Griffee, one of our critical care echocardiographers. Finally we have two exceptional lectures given by my lung ultrasound mentor, Dr. Alberto Goffi, a true international expert in this space.

FAST Exam for Anesthesiologists

Dr. Jimmy Fair, emergency medicine ultrasound guru, reviews the FAST exam with a focus on the value of these techniques for anesthesiologists. If you don’t think this applies to you, remember that every surgery is penetrating trauma!

“Complete” TTE

In this talk, Dr. Nguyen does her level best to discuss the breadth of a complete TTE exam in just a half-hour. Yikes, is that a lot to cover!

Echo to the Rescue – Condensed Version

This is a couple different single-lecture versions of rescue echo. This is a big topic, probably not appropriate for a single talk, but I’ve tried my best. If you just want to dip your toe in the rescue water with a brief introduction, here you go. (Test your knowledge here!)

Echo to the Rescue, Now We’re Talkin’! – Part I, Volume and Afterload

Now this is more like it! I’ve made a giant rescue echo talk, almost 120 slides, but to avoid echo overload I’ll break it down into four bite-sized pieces. This first round is an introduction to the concept as well as a discussion of hypovolemia and low afterload.

Even More Rescue Echo, Part II – Dynamic Obstruction and Pulmonary Embolism

Ready for more? This lecture will highlight evaluation of dynamic obstruction and PE. When should you consider these diagnoses? Every time you image!

Rescue Echo, Gotta Love It! – Part III, Tamponade and Ventricular Failure

Three meaty topics to be sure. Is LV failure the cause or the result of hemodynamic instability? Isn’t the RV just a passive conduit? The answers are here!

Rescue Echo, Can’t Get Enough! – Part IV, Valve Disease, PTX, Arrhythmia

Stay with me! This is the home stretch for rescue echo and includes some super important concepts. If you’re not looking at the lungs, are you really doing a complete rescue study? Hmm. And what’s this talk about pseudo-PEA?

Rescue Sheet

This link is for a work-in-progress rescue echo sheet I’m developing. It’s designed to be taken to the bedside every time you do a rescue echo and used to keep you on track. I welcome any feedback!

Pericardial Tamponade

This talk by Dr. Michelle Curtis focused just on pericardial tamponade, from both a TTE and TEE perspective.

Global LV Function

Drs. Zimmerman and Bledsoe discuss the evaluation of global left ventricular function, focused primarily on transesophageal imaging, including 2D, 3D, and Doppler. (Test your knowledge here!)

LV Ischemia

In this talk Dr. Michelle Curtis will review myocardial ischemia and LV regional wall motion.

Introduction to Stress Echocardiography

Dr. Morrissey provides us an excellent introduction to the techniques of stress echocardiography from the unusual perspective as one of the only anesthesiologists in the country to be interpreting these studies clinically.

Basic Aortic Valve Anatomy and Assessment

Drs. Chang and Montzingo introduce us to the anatomy of the aortic valve and the best views from which to assess it. These are the basics, you can never review them too much.

Aortic Stenosis – The Basics

Drs. Birgenheier and Heath review evaluation and quantificaiton of AS, one of the most common cardiovascular diseases we’ll encounter. This is our bread and butter! (Test your knowledge here!)

Aortic Stenosis – Beyond the Basics

This talk (by yours truly) is a little more advanced but absolutely important. We’ll discuss the complexities of turning a simple concept (quantifying aortic stenosis) into accurate information as well as a variety of hemodynamic states that complicate these measurements. I may even throw in a little fluid dynamics!

Aortic Insufficiency

Another excellent lecture by Dr. Bledsoe, need I say more? OK, fine, this one’s about evaluation of aortic insufficiency. Happy now? Just watch it. (Test your knowledge here!)

Aortic Valve Replacement Case Review

Dr. Gera will review a case of aortic valve replacement, from preoperative assessment to postoperative complications

Anatomy and Imaging of the Mitral Apparatus

Every year I seem to put in more mitral valve talks, and now I’ve decided we need a separate lecture just about the anatomy of this fantastically complex system before we delve into the echo assessment. So sue me! There are 3 talks here – a live one combining apparatus and imaging, and two studio versions that separate the topic.

Mitral Regurgitation

In this two-part series, Drs. Bledsoe and Harig review the current best practices in evaluation of mitral regurgitation. This is a very high-yield topic, and should be reviewed frequently. (Test your knowledge here!)

Intraop Echo for MitraClip

Dr. James Lee, expert echocardiographer and cardiac anesthesiologist, discusses the complexity of imaging patients during MitraClip placement. Not to be missed!

Mitral Stenosis

Thanks to Dr. Pulsipher for this excellent, concise review of evaluation of mitral stenosis. (Test your knowledge here!)

Tricuspid and Pulmonic Valves

A lot to cover in one lecture, and we have a couple in here. Dr. Morrissey’s updated version is a great update on this complex topic!

Evaluation of Bioprosthetic Valves

In part 1 of the prosthetic valve discussion, Dr. Decou reviews the echocardiographic evaluation of bioprosthetic valves, a common task for the perioperative echocardiographer.

Mechanical Valve Assessment

More key content from Dr. Decou for part 2 of the prosthetic valve fest

Prosthetic Valve Assessment

This talk is a nice review of the assessment of both mechanical and bioprosthetic valves by Dr. Smith

Prosthetic Valves – Patient Prosthesis Mismatch etc.

Great talk by Dr. Jen Chang on a particularly complex issue in the assessment of prosthetic valves.

Right Ventricular Function

The critical concepts of right ventricular structure and function are reviewed in these not one, not two, but THREE exceptional talks by Drs. Morgan, Skaggs, and Silverton.

Echo in Systemic Diseases

Thanks to Drs. Bledsoe and Kenlan for these excellent talks about the echocardiographic findings of both common and rare systemic diseases.

Diastology

In these two lectures, Dr. James Lee and I will try to break down this enormous, complex, and fascinating topic into something manageable. See how we did! (Test your knowledge here!)

Echo in Dilated Cardiomyopathy

In this talk I’ll introduce the concept of cardiomyopathy, and review the echocardiographic characteristics of dilated cardiomyopathy. I was in a TTE mood when I made this, so most of the images are transthoracic.

Echo for “Non-Dilated” Cardiomyopathy

In this lecture Dr. Morgan will review the evaluation and echocardiographic characteristics of the remaining types of cardiomyopathy.

TEE Evaluation of LVAD

As discussed in the cardiomyopathy lectures, heart failure is everywhere and transplants are not. Whatever your practice it will be hard to avoid LVAD patients in the future. Drs. Griffee and Pulsipher reviews the history and echocardiographic assessment of these complex devices.

Case Presentation – Cardiomyopathy

Stodgy lecture content is fine, but it’s important to put it all together with real-life discussions. In this talk Dr. Curtis review’s cardiomyopathy in a case-based format.

Echo in Pulmonary HTN / RV Failure

Fantastic lecture by Dr. Matthew Griffee on echo assessment of the struggling right ventricle.

Echo in Organ Transplantation

Dr. Khorashadi reviews the use of TEE in patient’s undergoing a variety of organ transplants.

More Excellent Cases!

Two different case review lectures by Dr. Heath and Dr. Griffee. This is the practical application of echo and represent very high yield, practical discussions.

Aorta Part 1: Atherosclerosis

One of my very favorite topics, the oft-overlooked and frequently under-appreciated thoracic aorta. Enjoy!

Aorta Part 2: All the Rest

Dr. Curtis delves into the fascinating world of dissection and aneurysm

Quantitative Hemodynamics

This talk is a nice overview of the use of cardiac ultrasound for quantitative assessment. Bread and butter, but very important!

Congenital Heart Diseases, Multiple Talks!

In this great series of lectures, Drs. Linda Nguyen and Ned Morgan review and help simplify these complex topics.

In this 3 part series, Dr. Decou delivers the most interesting series of ultrasound physics lectures every heard by man or beast. Seriously, this is an important topic, and her review is top notch! (Test your knowledge here!)

Peribypass Complications

We love it when things go well, of course, but that isn’t always the case, right? In this talk, Dr. Pelegrin will review a number of the problems we should keep in mind.

Echo for TAVR

Dr. Morgan’s excellent talk will review the use of echo to assess patients before, during, and after TAVR. Don’t do these cases? You will soon!

TEE for Left Atrial Appendage Occlusion

Dr. Montzingo reviews the current state of left atrial appendage closure in this excellent lecture.

Intro to 3D Echo

3D echo is the topic for an entire lecture series by itself, but in this talk Dr. Montzingo will when our appetite for this growing area of perioperative echo.

Perioperative Echo in Endocarditis

Who doesn’t love looking at echo images of endocarditis? My lecture will be full of them, and maybe a little echo Rorschach as well! (Test your knowledge here!)

TEE for Cardiac Source of Embolus

An important topic and a great review by Dr. Borgmeier

Abdominal Ultrasound for the Anesthesiologist

Dr. Linda Nguyen does a great job reviewing the value of abdominal ultrasound for the perioperative provider. I can assure you, this has applications in your practice!

Cool (Non-cardiac) Stuff You Should Ultrasound!

Dr. Silverton’s excellent talk gives us a number of new ideas for things to ultrasound, check it out.