Practical Perioperative Transoesophageal Echocardiography

Practical Perioperative Transoesophageal Echocardiography David Sidebotham, Alan Merry, and Malcolm Legget Sydney: Butterworth-Heinemann (an imprint of Elsevier Science Limited), 2003. ISBN 0-7506-5496-1. 266 pp + CD-ROM, $74.95. As its title suggests, this text, a succinct, noncomprehensive review of the salient information pertinent to the practice of perioperative echocardiography, is focused for the cardiac anesthesiologist and intensivist. It has a number of distinguishing features, including over 400 video loops contained in the CD, which very nicely compliments the well-written and already well-illustrated text. Despite having multiple authors contribute to the text, the perioperative focus, nomenclature, and consistency of style indicate an exceptional editing effort. Other strengths of the text include excellent line illustrations and tables as well as the aforementioned video examples. The CD itself is easy to navigate and the video examples are juxtaposed with still frames and illustrations that make appreciation of the pathology quite easy. The editors have generously included a feature that allows the reader to download the video and still frame examples into presentation software such as PowerPoint. Thus, readers can use this resource to create their own teaching tools. Although they are greatly overshadowed by the strengths of this text and CD, a few weaknesses deserve mention. By design, this text is not comprehensive, and it contains a limited number of references. Quantitative assessment techniques are relegated to a single chapter. The video examples mentioned above are relatively small in size (occupying about a fifth or less of the average computer screen). This is smaller than usually viewed in clinical practice and makes appreciation of a few issues difficult. The resolution of the echocardiograms is good but not outstanding. Obviously, there was an effort to limit the size of files in order to put as many as possible on the CD. Also, the chapters in the CD and the text do not directly correspond. For instance, there is no separate chapter in the CD on systolic left ventricular function. Instead, segmental wall motion abnormality examples are presented in the CD chapter on hemodynamic instability. Because of the focus on cardiac patients, users of transesophageal echocardiography in noncardiac patients will find little direct help from this text. The reader should be aware that the CD requires Quick Time™ software to play the video loops. In addition, there is no search function on the CD. However, a site map on the CD clearly lists every example by title. The first five chapters of the text provide a general introduction, including succinct but excellent reviews on the applicable physics, transducer design, and artifact generation. Concepts like refraction, transducer fundamentals, beam formation, and artifact origins are clearly explained and diagramed. Basic equations important to Doppler echocardiography are derived and explained simply but quite effectively. In addition, the basic examination and cross-sections are very nicely reviewed utilizing line drawings that depict beam orientation and cross-sectional anatomy. Chapters 6 through15 address clinical topics beginning with hemodynamic instability. In Chapter 6, the common causes of hypotension are listed and systematically addressed. They are very well complemented by examples on the CD. In Chapter 7, systolic left ventricular function is reviewed, and the important topic of segmental wall motion abnormality associated with ischemia is reviewed in detail. This reviewer is puzzled that coronary occlusion and intracardiac air are treated as separate causes of segmental wall motion abnormality from myocardial ischemia. In addition, the statement that marked hypovolemia is associated with multiple segmental wall motion abnormalities is an overstatement of the study by Seeberger et al. However, overall, the topic is well covered, and the concluding checklist in this chapter regarding segmental wall motion abnormality assessment after cardiopulmonary bypass is a very good and quite practical approach. Chapters 9 and 10 address the mitral valve and aortic valve in some detail. All the common techniques utilized for assessment of these valves are reviewed, albeit somewhat briefly. The complementary sections in the CD are excellent, and most of the major valvular abnormalities are illustrated by video loops. The concluding chapters on right-sided structures, transplantation, and congenital heart disease in adults are covered in much less detail. In summary, this is an outstanding multiauthored text and CD on transesophageal echocardiography. Readers from the United States should not be put off by the spelling of “transoesophageal” or the abbreviation TOE instead of TEE. This text contains a well-focused, succinctly presented, and beautifully illustrated summary of the current state of perioperative transesophageal echocardiography. This reviewer highly recommends it to those preparing to enter the field as well as experienced users of transesophageal echocardiography.