Comprehensive Textbook of Intraoperative Transesophageal Echocardiography. Edited by Robert M. Savage, M.D., F.A.C.C., and Solomon Aronson, M.D., F.A.C.C. Philadelphia, Lippincott Williams and Wilkins, 2005. Pages: 716. Price: $199.00.

This textbook reviews the practice of intraoperative transesophageal echocardiography (TEE) in eight sections and 38 chapters. The first section discusses the principles of echocardiography in 4 chapters. The challenging topic of physics in echocardiography is clearly and comprehensively covered in the first chapter. The remaining 3 chapters in the first section deal with the fundamentals of digital echo, artifacts, and image enhancement.

The second section details the performance of an intraoperative echocardiographic examination in 16 chapters. The first 5 chapters review relevant anatomy, major echo views, indications, contraindications, and organizational aspects. Although chapter 9 discusses statistical considerations in echocardiographic outcome research very well, it does not provide major examples from the TEE literature that would illustrate the principles identified, e.g. , specificity and specificity in endocarditis, diagnostic accuracy in mitral valve prolapse and aortic dissection. These aspects are later discussed, but the importance of this chapter might have been further highlighted with important illustrative TEE examples. The remaining 11 chapters in section 2 review the conduct of the intraoperative examination in standard categories such as systolic function, diastolic function, valves (native and prosthetic), great vessels, masses, and congenital disease.

With the principles and conduct of intraoperative TEE covered in the first two sections, the remaining six sections delineate how TEE may guide perioperative decision making. The clinical areas covered are as follows: coronary artery disease (4 chapters), valvular heart disease (4 chapters), heart failure (5 chapters), thoracic aortic disease (1 chapter), noncardiac surgery (1 chapter), critical care (2 chapters), and the interventional cardiology laboratory (1 chapter).

These eight sections together make this textbook truly comprehensive in scope because they cover the full spectrum of intraoperative TEE: the principles, the examination, and integration into clinical practice. Thus, detailed analysis of the contents of this textbook shows that it indeed merits its title. Furthermore, the editors are leading educators in intraoperative TEE. Their multidisciplinary team of more than 70 contributors further underlines the comprehensive nature of this text. As one reads through this textbook in detail, one thoroughly agrees with the editors who state in their foreword: “This textbook should be recognized as the cumulative knowledge of a collaborative team of leading surgeons, cardiologists and anesthesiologists who have witnessed and advanced the transformation of a once novel tool in clinical practice to its current conventional application.”

The content of each chapter is typically organized with titles, abundant illustrations (graphs, line diagrams, TEE pictures), tables, key points, and multiple-choice questions. This chapter format successfully renders the content accessible to the reader, regardless of experience level. The content is completed by a comprehensive index, answers to the multiple-choice questions, and summary tables of normal values, hemodynamic calculations, and grading systems in TEE. This clear format is a major strength throughout the textbook.

No textbook review is complete without comment on possible weaknesses. To my knowledge, there are no major ones. I have used this text in my everyday practice for 3 months already and have not found it lacking yet. Perhaps more intraoperative photographs of the pathology diagnosed during TEE would add further value to the already excellent content.

I congratulate the editors and their team. I agree with the following comment in their foreword: “it is the purpose of this text to … provide the perioperative clinician with an-up-to-date understanding of the current state-of-the-art transesophageal echocardiography and its potential applications.” This work not only fulfills its purpose, but will probably become a classic in the field, as summarized in the foreword by Michael Roizen.

I highly recommend this source as a frequent reference for every intraoperative echocardiographer for every aspect of intraoperative TEE: learning, teaching, preparing for certification, and caring for patients. It will rapidly become a versatile and standard reference in many libraries for all these purposes.

Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.