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His Special-TEE: One Physician Shares His Passion About the Latest in Echocardiography

Cover Story

Issue: April 2010

By: by Diane Barney

If you want an unbeatable view of a beating heart, forget about the typical ultrasound, which forces you to peer through layers of fat, bone and muscle.

The best path is down the esophagus.

That’s why, for the past 15 years, doctors have turned to a procedure called Transesophageal Echocardiogram – also known as TEE – for a close-up look at the heart’s function. But only in the last year has the technology in the Bay Area grown so stunningly accurate that its high-definition views are getting rave reviews from physicians.

“It offers a 4D experience,” explains Dr. Filip Roos, director of cardiac anesthesia at NorthBay Medical Center in Fairfield. “That’s like 3D in motion.”

That view comes courtesy of the Philips iE33, a piece of equipment that was purchased and installed in April 2009 as part of NorthBay Medical Center’s new Cardiovascular Operating Room.

“It’s just the best,” says Dr. Roos. “It allows me to view the heart from every angle and in amazing detail.”

To say that Dr. Roos is passionate about TEE is a bit of an understatement. The Prague-native, who had an internal medicine internship and anesthesia residency at UC San Francisco, spends as many hours as possible either performing the procedure, examining the views from all angles on the computer, or praising its capabilities to all who will listen.

“It’s my obsession,” Dr. Roos admits with a smile.

Dr. Roos is not only TEE board-certified, the highest level of certification for TEE in the United States, but is also TEE-certified by the European Cardiology and Echocardiography Society, which is the highest level of certification in Europe. He also has passed the board exam designed for cardiologists, which covers all forms of echocardiography.

“When I took the exam, there were fewer than 12 doctors in the world who had passed both tests,” he explains. “By now, there may be up to 50 doctors in the world who have done so.”

In March, Dr. Roos was honored with an invitation be a grader for the European Association of Echocardiography, a job that requires reviewing studies of other doctors and grading the quality of their work.

He understands that TEE exams are generally the job of the cardiologist.

“We cardiologists would typically consider this our specialty,” agrees Dr. Milind Dhond, medical director of Peripheral Vascular Program at NorthBay. “But when you have someone with Dr. Roos’ experience and skills, it can be a real advantage to work with him.”

Dr. Roos is mindful of the political landscape. “I don’t want to step on toes, but it takes a certain amount of dedication and practice to really master this equipment,” he says. “I do many, many of these each week; a typical cardiologist might only do one every two weeks or less.”

“It’s true,” confirms NorthBay anesthesiologist Jesse Dominguez, M.D. “Even cardiologists from other hospitals are turning to Dr. Roos to perform this procedure for them. It’s really rare that a community facility such as NorthBay would have this level of equipment and this level of expertise.”

In fact, Dr. Roos has led an eight-part lecture series at NorthBay, talking to doctors and clinical staff about his discoveries. A Lafayette resident, Dr. Roos also has privileges at John Muir Medical Center and Sutter Medical Center in Santa Rosa.

“We’re lucky to have him,” says Dr. Dominguez. “Dr. Roos is like a virtual university.”

The procedure is minimally invasive. An “echo transducer” – or probe – is placed in the esophagus while a patient is mildly sedated. A little bit of anesthetic is used to numb the throat. The doctor is then able to shift the probe down the esophagus and use ultrasound to see visuals of the heart. The probe can be rotated to capture different angles.

“The number of images I can take are endless,” says Dr. Roos. “I can rotate the probe 180 degrees. In traditional 2D TEE we are limited to certain views, but with 4D there are no limitations to the way I can look at things.”

Comparing 2D to today’s technology is like comparing black and white to color. With TEE -- in color, and with movement -- the image reveals depth and a clear look at any abnormalities that might exist.

A standard echocardiogram would involve placing a transducer on the chest, but the ultrasound has to travel through skin, fat, muscle, past the bones and lung tissue to “see” the heart, and that makes the image less detailed, explains Dr. Roos. In a TEE exam, the transducer is placed in the esophagus that is right behind the heart and that makes the image quality unmatchable.

“This cutting edge technology that we’re using here in Fairfield is easily comparable to the top academic centers in the United States and throughout the world,” he says, sounding like a proud father.

A few hospitals in the Bay Area have purchased the Phillips iE33, but NorthBay has been on the forefront of utilizing the technology according to Dr. Roos.

During cardiac surgery, Dr. Roos’ specialty is “hemodynamic management.” That means he’s watching to make sure the pulse, blood pressure and cardiac output are all on track. But this tool can do so much more, he explains. The procedure can also be used as a diagnostic tool, to determine possible risk factors, valve disorders, heart infections and best treatment scenarios.

“I can’t tell you how many patients I’ve seen in surgery, and I just know that if I’d had a chance to look at their heart five years earlier, they wouldn’t be in the operating room today but much earlier and the surgery would have been much easier.”

A leaky valve, for example, makes the heart work twice as hard.

“The heart’s an amazing machine. It can work nonstop for 90-plus years. But if you have a leaky valve, and you make it work twice as hard year after year, you’ll pay the price,” he says.

To get to those patients who could benefit most from his iE33, Dr. Roos does his best to educate primary care doctors, hospitalists and intensivists to refer appropriate patients that could benefit from this procedure.

“It’s the gold standard for diagnosing valve disorders. About 48% of patients with valve disorders never get referred,” he says. “It’s under-diagnosed and under-managed. The public needs to know if they have a history of valve disorders, it’s easier than ever for us to check it out.”

TEE, he explains, has ushered in a new era for images of the heart.

“Even during open heart surgery, you can’t see how the heart functions from all angles. This technology can show us how well the heart is working. If we see an abnormality, we can save a patient’s life. We must dig deep and use this technology to its full extent.”

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