TEE Simulator Helps Facilitate Decision Making in Cardiac Surgery

Douglas Shook, MD demonstrates how transesophageal echocardiography simulation visually enhances the educational experience for residents, fellows, faculty, and staff.

The advent of 3D transesophageal echocardiography (TEE) has given cardiac surgeons the means to better communicate with cardiac anesthesiologists as they reveal valvular and other heart diseases. Learning to use this 3D technology has recently gone beyond the echo room to simulation training.

The Saturday morning STS/SCA session on Integrating Perioperative Echocardiography Into Cardiac Surgical Clinical Decision Making featured a demonstration of the HeartWorks TEE simulator by Inventive Medical.

The virtual TEE probe generates simulated ultrasound images, which are derived directly and continuously from the 3D heart model. With the standard flexion, rotation, and angulation capabilities of a multi-plane probe, students can maneuver through the manikin’s esophagus and see the underlying anatomy of the 3D heart, along with an echocardiogram generated by the 3D heart on a split computer screen.

“One of the joys I have is working with surgeons, and one of the main tools we use is echocardiography to make sure the plane flies steady. This is a fully integrated TEE simulator that helps people understand how to get images,” said co-moderator Stanton K. Shernan, MD, Director of Cardiac Anesthesia Services at Brigham and Women’s Hospital and a Professor of Anesthesia at Harvard Medical School in Boston.

Douglas Shook, MD demonstrated how TEE simulation visually enhances the educational experience for residents, fellows, faculty, and staff.

“The beauty of the simulator is that it allows you to integrate the two images—your anatomy and what you see echocardiographically—in a way that helps you better understand what you’ll see in the operating room. That ability to move your probe is one of the most powerful things you have in the operating room to understand and get a feeling for a valve pathology,” said Dr. Shook, Assistant Professor of Anesthesia at Harvard Medical School and Program Director of the Cardiothoracic Anesthesia Fellowship and Director of Cardiac Interventional Anesthesia at Brigham and Women’s Hospital.

An added benefit is how the TEE simulator facilitates communication.

“All of us will get lost in the image if we can’t anticipate what’s about to happen. A lot of times, your echocardiographer will quickly move the probe around and tell you what you’re looking at,” Dr. Shook said. “It allows you the opportunity to have that conversation about precisely what you’re doing.”