The growing widespread use of transesopha-1 geal echocardiography (TEE) has led to apprehension regarding the consequences of uncontrolled use of the technique by inexperienced personnel. Numerous authorities have emphasized that the operator of TEE imaging systems must possess considerable technical and interpretive skills to avoid the possibility of furnishing false and misleading data. &dquo; These misgivings are particularly applicable to the field of intraoperative TEE, in which misdiagnoses can result in immediate and irreversible erroneous therapeutic strategies.The results of a recently completed survey of 108 anesthesiology residency programs in the United States indicated that anesthesiologists are primarily responsible for interpretation of TEE data in more than half (54%) of the parent institutions of these programs.7 Most of these anesthesiologist-echocardiographers have received no formal training in TEE.7 This situation is unlikely to change in the immediate future, because most anesthesia departments do not offer fellowship-level training in TEE and, to the author's knowledge, there are no pending accreditation requirements to obligate anesthesia residency programs to furnish training in echocardiography. This is quite unlike the situation in cardiology residency programs, in which residents are expected to perform a minimum of 150 transthoracic echocardiography (TTE) studies and to interpret a further 150 studies before completing their training.8The early clinical use of intraoperative TEE was primarily limited to monitoring left ventricular function and to the detection of intracardiac air. However, the diagnostic yield from TEE far exceeds these restricted applications. It is now generally accepted that the anesthesiologist who wishes, or, more and more commonly, is expected, to provide TEE services should possess the skills necessary for acquisition and interpretation of a complete patient examination. This has generated interest in the development of standards for TEE training, credentialing, and certification. This report provides an overview of the current status of these topics and concludes with a description of the organizational structure of an intraoperative TEE service.
