Year : 2014  |  Volume : 17  |  Issue : 4  |  Page : 263--265

Exponential growth of tranesesophageal echocardiography in India in the last decade: Contribution of Indian association of cardiovascular thoracic anesthesiologists

Poonam Malhotra Kapoor 
 Department of Cardiac Anaesthesia, Cardio Neuro Centre, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Poonam Malhotra Kapoor
Department of Cardiac Anaesthesia, Cardio Neuro Centre, All India Institute of Medical Sciences, New Delhi

How to cite this article:
Kapoor PM. Exponential growth of tranesesophageal echocardiography in India in the last decade: Contribution of Indian association of cardiovascular thoracic anesthesiologists.Ann Card Anaesth 2014;17:263-265

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Kapoor PM. Exponential growth of tranesesophageal echocardiography in India in the last decade: Contribution of Indian association of cardiovascular thoracic anesthesiologists. Ann Card Anaesth [serial online] 2014 [cited 2020 Jul 8 ];17:263-265
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Perioperative transesophageal echocardiography (TEE) has evolved in the couple of decades, as a tool for carrying out perioperative cardiac procedures. "TEE stethoscope" is now widely used by cardiac anesthesiologists and have become experts in this area. There are reports of the TEE use even in noncardiac situations. [1] TEE is aimed at providing a suitable tribune to the current status of the heart and great vessels. TEE is the "hot material" of the first choice investigation in the armamentarium of an anesthesiologist today; particularly, when time is not an independent variable. It has put the anesthesiologist's position in the driver's seat in cardiac surgery that is responsible for diagnosing, and assessing the adequacy of the surgical repair. [2]

Transesophageal echocardiography has a variety of uses that expand from the cardiac operating rooms into all areas of medicine. TEE and its use in high-risk noncardiac surgery such as vascular surgery, liver transplants, orthopedic surgery amongst other areas has been described extensively. [3] The important contribution of TEE during extracorporeal membrane oxygenation and left ventricular assist device implantation cannot be undermined and managing complications related to cannulae and weaning has become much easier with this "visualization." The yardstick signifying its growth is the meteoric rise in the sale of the TEE machines by many manufactures in the last few years. It may replace the pulmonary artery catheter use as a diagnostic cardiac modality.


0Indian association of cardiovascular thoracic anesthesiologists (IACTA) has a mammoth contribution in advancing and nurturing TEE in our country. IACTA should be commended for creating perioperative TEE guidelines in a clearly, written document in. Annals of Cardiac Anesthesia. [4] IACTA has also taken upon itself the responsibility to train novices in TEE. Proficiency in TEE is maintained by an annual workshop which is preceded by a continuing medical education comprising of "hands on" training and a wet lab" of TEE training are maintained. The IACTA's TEE workshop along with dedicated TEE faculty continues to push the boundaries in development and application of emerging echocardiography technologies (i.e. tissue Doppler imaging and three-dimensional imaging). The ongoing efforts of our erstwhile President of IACATA, Prof. Kanchi Muralidhar needs special mention and accolades here.

Indian association of cardiovascular thoracic anaesthesiologists through its Education and Research cell (IERC) started in 2008, under a chairperson, controller of examination, coordinator and a team of eleven highly academic leaders in TEE are all active in facilitating this TEE academic activity through the years by being able to enroll more than 107 FIACTA students in the past 8 years with 25 FIACTA centers across the country being on a linear rise [Figure 1]. TEE training is an essential part of the syllabus and refresher courses and workshops on basic and advanced TEE are held in Delhi and many state branches of IACTA.{Figure 1}

This has enabled IACTA to hold Annual TEE examination which is accredited by the American Society of Echocardiography, Indian Academy of Echocardiography, University of Minnesota (USA) and University of Leipzig (Germany). Recently, the eight TEE workshop was culminated. A total number of 101 candidates from all over India chiefly, cardiologists and cardiac anesthetists have taken the examination [Figure 2]. Four dedicated TEE textbooks have been authored in the recent past by the Past and incoming Editor of Annals of Cardiac Anesthesia, to help serve as guides for better understanding of the subject. [5]{Figure 2}

In the preceding 10 years up to 30% of articles in ACA are about TEE in the form of either tutorials or review articles, or original articles or case reports. In the current issue of the journal, about 35% of the articles are on TEE including an original article on "Echocardiography derived three-dimensional printing of normal and abnormal mitral annuli. [6]" The fact that TEE can markedly aid in changing the course of surgical plan has been shown in case reports like TEE for detecting the presence of a right atrial myxoma, large Eustachian valves (inferior vena caval cannulation avoided and thus the potential complications), [7] the use of TEE in localizing foreign bodies and in detecting musculoskeletal disorders like "TOE Thumb" syndrome all are a part of this issue. The myth that patent ductus arteriosus cannot be diagnosed optimally on TEE was nullified wherein, Ranjani et al. show that, visualization of ductus using TEE could be optimal. These authors have shown that the proximal left pulmonary artery and the descending aorta and the ductus between these two structures, could be well-visualized by TEE. Singh et al. have presented an unusual case of a partially ligated left atrial appendage (Sarvesh Pal Singh et al.). [8]

I would here, like to thank Dr. Praveen Neema, my predecessor for being a competent editor and ensuring a farsighted, selective and rigorous, but thorough peer-review system and ensuring in maintaining a high quality of this journal. He described that practically every journal issue has been seeing an average of 5 publications on TEE, indicating the growing expertise in TEE.

Spiritually, I feel, TEE is a tool that helps to train our unconscious mind; for TEE is like an iceberg mostly unknown to our conscious mind. The unconscious mind performs actions according the Samskaras and Karmas of the past. Our objective as perioperative physicians should be to move from unconscious incompetence to unconscious competence. Whatever we do, for better patient outcome, we, as defined in the 2 nd chapter of Bhagwad Gita should be as the "Stitha Prajna" that is, in a state of flow. Mihaly Csikszentmihalyi, defined flow as the zone where skills match the challenges that a person sets upon himself, and TEE is a challenge both mental and skillful. We all should be a part of the campaign to conquer this skill.


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6Mahmood F, Owais K, Montealegre-Gallegos M, Matyal R, Panzica P, Maslow A, Khabbaz KR. Echocardiography Derived Three-Dimensional Printing of Normal and Abnormal Mitral Annuli. Annals of Cadiac Anaesthesia 2014;17:279-84.
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