Clinical Transesophageal Echocardiography: A Problem-oriented Approach, 2nd edition . By Steven N. Konstadt, Stanton Shernan, Yasu Oka. Philadelphia, Lippincott Williams & Wilkins, 2003. Pages: 452. Price: $199.00.
The use of transesophageal echocardiography (TEE) has increased dramatically over the past few years, and it is now the standard of care for most cardiac surgical interventions. With the introduction of guidelines for certification by the National Board of Echocardiography (Raleigh, North Carolina) and the ability to become board certified in this subspecialty, there is an increasing demand for specialized education and training in the optimal utilization of perioperative TEE. Whereas most of the standard echo literature refers to the transthoracic approach used by cardiologists, this book deals exclusively with the use of TEE in the perioperative period. The editors have combined elements of two earlier books (Oka and Goldiner1and the first edition of this work2) and produced an up-to-date review of perioperative echocardiography. It includes the special considerations of modern surgical techniques and of recent technical advances in echocardiography equipment. For example, the authors have integrated new surgical procedures such as minimally invasive aortic repair, and the many pictures in the book consist almost entirely of multiplane TEE views.
The 28 chapters are organized into three sections: (1) Basic Principles, (2) Clinical Applications: Fundamental Concepts, and (3) Problem-oriented Case Discussions: Application of the Fundamental Concepts to Clinical Scenarios. As the title indicates, this book clearly focuses on the clinical aspects of TEE. The first 60 pages about basic principles are more of an introduction to the topic than an in-depth review. The novice reader will need to consult other works for adequate background knowledge. Despite this limitation, the section includes an excellent overview on emerging technologies in echocardiography, such as contrast and three-dimensional echocardiography. It also contains a thorough discussion about the safety of intraoperative TEE, with an extensive review of the current literature.
The second section describes how to systematically evaluate the different anatomical structures. In this part, one can find an excellent description of the echocardiographic evaluation of prosthetic valves, a challenging task even for the most experienced clinicians. Many pictures of valvular dysfunction and 18 case reports aid the understanding of potential problems in these patients. However, some of the material is redundant, with discussions of similar topics in the problem-oriented chapters in the third section of the book. For example, later chapters contain five more examples of valvular dysfunction. Given that different authors have contributed the different chapters, differences in approach are often noticeable.
The unique third section of the book features a selection of frequently encountered clinical situations in which basic knowledge is transferred into clinical practice. Some of the information presented here can otherwise be difficult to find and frequently requires the consultation of several journal articles. Here, the topics are combined with multiple case reports covering many of the common problems that one is likely to encounter in and outside of the operating room. The section starts with the use of echo for the evaluation of cannulas, catheters, intraaortic balloon pumps, ventricular assist devices, and occluders. The chapter about considerations in patients with congestive heart failure or hemodynamic instability includes case reports where TEE is used for differential diagnosis while performing cardiopulmonary resuscitation. In the basic and problem-oriented chapters, many pictures and diagrams on the assessment of the aorta help one to understand the challenges one is likely to encounter when evaluating aortic dissection and aortic atherosclerosis. The specific echo considerations for patients undergoing surgery for hypertrophic obstructive cardiomyopathy and endovascular stent grafting of the aorta are included in the problem-oriented section. There are also case discussions on echocardiography in patients with left ventricular pseudoaneurysm or cardiac trauma. The section ends with a chapter on the special problems of patients undergoing lung transplantation and their echocardiographic evaluation.
This edition is clearly structured and introduces some new tools to help the reader focus on important elements. A new feature is a list of key points that follows each chapter and summarizes the most pertinent information. At the end of each chapter, there is also a comprehensive list of references that includes the most recent literature up to the year 2002. The authors have marked suggested readings in bold letters. One weakness of the book is that the index could have been better cross-referenced. For example, there are separate but unlinked entries for pulmonary arterial catheter and Swan-Ganz catheter .
In summary, this second edition is aimed at both the novice and the experienced practitioners of TEE, including the basics of echocardiography as well as answers to specialized clinical questions. For each clinical situation, the book explains the role of TEE in the decision-making process and highlights the essentials of a relevant TEE examination. The book contains information essential to clinical practice and preparing for the Perioperative Echocardiography Examination of the National Board of Echocardiography. I highly recommend it.
St. Luke’s Roosevelt Hospital Center, Columbia University, New York, New York. jbrechmann@chpnet.org.
