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In the United States it takes six years for a civilian to become a professional cardiologist, three years in cardiology and three years in internal medicine. It takes four years in the United States Navy, and I completed in three. The use of ultrasound technology called echocardiography allows a professional cardiologist to study the physics related to heart failure. There are many ways to induce transposition of the great arteries leading to the heart and the transposition depends on where the arteries of the vessels and their assembly are located. There are procedures used to create atrial septal defect that occurs when the right ventricle pumps deoxygenated blood and it enters the bloodstream from the aorta artery. Once induced, it is nearly impossible to reverse, and the right atrium becomes the receiving vessel when the blood returns to the left atrium the goal is achieved." Michael explained heart surgery as he continued. He also explained once the chest was opened, there were several ways he could induce death.