**7. References**


or have quite limited theoretical knowledge of ultrasound technologies, learning this examination is a little more difficult. The emphasis here is on the word "little", highlighting that this examination is quite straightforward and simple to perform and therefore to learn. Also, interpreting the images is equally very simple since it is obvious from first principles without any formal training, and the precise locality of atheroma is similarly very easy to appreciate since it is always directly beneath the ultrasound probe at the time. Surgeons do not require additional anatomy training; indeed the level of anatomy knowledge is the greatest of all specialties and even trainees have an extremely good understanding of anatomy. It would be expected that an advanced surgical trainee should be able to competently and confidently perform and epiaortic ultrasound examination after about 10- 20 supervised cases. With previous practical and theoretical experience in ultrasound or

Learning epiaortic ultrasound examination may be a sufficient enough stimulus to engage in a wider use of ultrasound technologies. In the current advanced cardiac surgical management, the use of ultrasound by cardiac surgeons should become a matter of routine daily practice. Performing transthoracic echocardiography in the pre-and post-operative settings, ultrasound guided procedures including pleural drainage and ultrasound lung examinations are quite straightforward and simple to learn. However, specific postgraduate training in addition to advanced surgical training should be undertaken; specifically it is not yet integrated as part of an advanced training program. A variety of postgraduate courses are available including university-based courses. These may cater for general (non-cardiac) clinical practice, or for an advanced diagnostic (cardiac) practice. Our program may be

The predominant cause for cerebral atheroma embolism in cardiac surgery using cardiopulmonary bypass relates to dislodgement of aortic atheroma with embolism caused by manipulation of the aorta. Transoesophageal echocardiography is not able to visualise the distal ascending aorta and proximal aortic arch due to the presence of air in the bronchi crossing between aorta and oesophagus. Epiaortic ultrasound is able to assess this portion of the aorta; and in addition is far more accurate than manual assessment by the surgeon's

A standardised comprehensive echocardiography protocol is proposed. The performance of this ultrasound examination is relatively straightforward and is fairly easily taught. It is

Barbut, D.&J. P. Gold (1996). Aortic atheromatosis and risks of cerebral embolization. *J* 

Calafiore, A. M., M. Di Mauro, et al. (2002). Impact of aortic manipulation on incidence of

cerebrovascular accidents after surgical myocardial revascularization. *Ann Thorac* 

finger. Avoiding the atheroma however, requires a change to the surgical strategy.

echocardiography, it may only be 5-10 cases.

reviewed at www.heartweb.com

**6. Summary and recommendations** 

recommended that it be before routinely.

*Surg* 73(5): 1387-1393.

*Cardiothorac Vasc Anesth* 10(1): 24-29.

**7. References** 


**Part 2** 

**Echocardiography in Heart Failure** 

ascending aorta in patients undergoing cardiac surgery. *Acta Anaesthesiol Scand* 52(9): 1179-1187.

