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Practical Echocardiography: The Heart of the Matter. Part 1, Basics

2001; Lippincott Williams & Wilkins; Volume: 92; Issue: 1 Linguagem: Inglês

10.1097/00000539-200101000-00069

1526-7598

Emýne Pelýn Karaca, Johanna Schwarzenberger,

Cardiac Imaging and Diagnostics

Practical Echocardiography: The Heart of the Matter. Part 1, Basics Kathinka Peels and Erik KorstenCD-ROM, Windows 95/98 or NT and Internet Explorer 4.0 or higher. Catharina Hospital, Eindhoven, Netherlands. Available by e-mailing Dr. Peels at [email protected] or faxing +31–40–2447885. $30.00 or 30 euros. Dimitry Baranov, MD, Department of Anesthesia, University of Pennsylvania, Philadelphia, PA This CD-ROM is a compilation of video and audio information related to cardiac echocardiography. Dr. Peels, a cardiologist, and Dr. Korsten, an anesthesiologist, have described an interdisciplinary approach to the study of echocardiography. The target audience for this CD-ROM is primarily the beginner in cardiac echocardiography. However, the more advanced practitioner of transesophageal echocardiography (TEE) in the operative setting may enhance his proficiency with the study of standard transthoracic views. The system requirements for the CD are a Windows 95/98 or NT operating system with an Internet browser (either Microsoft’s Internet Explorer or Netscape, Versions 4.0 or higher). This browser software is free and can be easily downloaded from the Internet. Installation of the CD-ROM requires approximately 4 MB on the hard drive. Microsoft’s Media Player Version 6.4 is used to view the video clips. The Media Player is installed automatically if the CD-ROM setup program does not detect it on the hard drive. The title of the CD-ROM “The Heart of the Matter” reflects the didactic goal of the authors. Because knowledge of cardiac anatomy is the most important step in becoming a successful interpreter of 2D echo images, this CD-ROM focuses on the examination of the healthy heart. In contrast to texts written on echocardiography, the use of a web browser to navigate through the CD-ROM material is a significant advance in creative teaching of echo-based normal cardiac anatomy. As basic World Wide Web literacy becomes a prerequisite for using the CD-ROM successfully, this software setup is ideal for a multimedia approach for an echo tutorial. By clicking on the “Forward,” “Back,” or “Home” icons of the web browser or by using hyperlinks, the student has complete access to all levels of the tutorial. Provided the CD-ROM user is also online, echocardiography-related resources on the Internet can be surfed simultaneously. The CD-ROM has a “homepage” that includes links to the “Heart of the Matter,” the “Visible Human,” and “TTE & TEE” (transthoracic echocardiography & TEE). The “Heart of the Matter” link is the access to the main tutorial. A separate site outlines the tree structure of the tutorial. A link to this overview is available on each “web site,” thus allowing the user to identify the rank of each teaching step. The “Visible Human” link accesses anatomical portraits of the thorax from the Visible Human Project of the National Library of Medicine, Bethesda, Maryland. In this project, a dissection of a real human body has been digitized so that relevant sections of the thorax can be studied in continuous video loops side by side with echo-based videos on the CD-ROM. The “TTE & TEE” link is a compilation of other echocardiography teaching sites available on the Internet that diversify the approach to learning echocardiography. Despite the fact that the three hyperlinks on the home page are derived from various authors, the thrust of the CD-ROM is in teaching how to create a 3D image from a 2D echo picture. A structured transthoracic examination is the core of the tutorial. The position of the patient and the transducers for the standard views are demonstrated in videoclips. A laser pointer on the patient’s thorax is used to demonstrate the anatomical axis of the ultrasound scanner, and anatomical drawings, accompanied by text, demonstrate the structures the transducer is likely to scan. Simultaneous videoclips of the TTE image show the anatomical relationships during the cardiac cycle. All standard TTE and TEE views are covered in depth, including color and Doppler examination. The quality of the digitally stored videoclips is excellent when using the 3 × 2-inch projecting box. However, some of the quality is lost when using the zoom mode to enlarge the video images. There is also great clarity in the accompanying audio tutorial. On most images, anatomical structures can be easily identified by clicking on the “hand” cursor. This becomes an important tool in the “explanation and answer” section of the echo quiz that follows each section of standard TTE and TEE views. The quiz is appropriately difficult, reaffirming previously presented 3D relationships of cardiac structures in relation to the scanning angle of the transducer. In addition to a complete tutorial on standard TTE and TEE views, the authors have included a physics section that describes the basics of ultrasound and the Doppler principle. Although there is minimal video or audio animation in this section, there is a hyperlink to other teaching web sites on this subject. The American Society of Echocardiography and Society of Cardiovascular Anesthesia (ASE/SCA) guidelines for performing a comprehensive intraoperative TEE examination are also available on the CD-ROM for reference as well as a “web page” decoding abbreviations related to echocardiography. What initially started out as a local teaching project at the authors’ institution has developed into a creative tool for teaching echo that reflects on the enthusiasm of its authors for the subject. Further projects, such as Part II of this tutorial, will focus on the mitral valve and its pathology. It is unfortunate, but understandable, that this CD-ROM cannot be used on Macintosh computers. The CD-ROM can be purchased be either e-mailing Dr. Peels at postbus @peelscard.demon.nl or FAX +31–40–2447885. The price of $30US or 30 Euros is a bargain considering the wealth of information provided. Further information on the project is available at http://www.vesalius.org.