A Practical Approach to Transesophageal Echocardiography, 2nd ed. Edited by Albert C. Perrino, Jr., M.D., and Scott T. Reeves, M.D. Philadelphia, Lippincott Williams & Wilkins, 2008. Pages: 493. Price: $99.00.

Cardiothoracic and cardiovascular anesthesiologists have widely adopted transesophageal echocardiography (TEE) as a diagnostic and monitoring modality, and are increasingly expected to provide the cardiovascular surgeon or interventionalist with information crucial for periprocedural decision-making. These developments are reflected in the program requirements for subspecialty training in cardiothoracic anesthesiology, and by the achievement of testamur status in the National Board of Echocardiography’s Examination of Special Competence in Perioperative Transesophageal Echocardiography (or the relevant recertification exam) by more than 3,000 physicians at the time of writing.

Constructive periprocedural application of TEE requires specific knowledge beyond an understanding of the general principles of echocardiography. This has led to the publication of several texts aimed at the perioperative TEE practitioner. For the second edition of their textbook A Practical Approach to Transesophageal Echocardiography , originally published in 2003, Drs. Albert Perrino and Scott Reeves have commissioned chapters from 28 contributors, including the editors. All authors are from North American institutions; many of them enjoy high name recognition in cardiothoracic anesthesiology.

The book has 21 chapters and is divided into 5 sections. The first section, Essentials of Two-Dimensional Imaging, deals with ultrasound physics, the standard two-dimensional examination, the evaluation of left ventricular systolic function, and the echocardiographic diagnosis of myocardial ischemia. The subject matter of the three chapters of section two, Essentials of Doppler Echocardiography, while somewhat self-evident, also includes the evaluation of diastolic function. Section three, Transesophageal Echocardiography in Valvular Disease and Surgery, is the largest part of the book. Mitral valve pathology and mitral valve repair are discussed in three chapters, aortic valve pathology is addressed in two chapters, and one chapter each deals with the evaluation of prosthetic valves and right-sided cardiac structures and function. Clinical Challenges, the fourth section, has five chapters covering TEE evaluation of the thoracic aorta, congenital heart disease, coronary revascularization, and cardiac masses, as well as application and utility of TEE in the intensive care unit. The fifth and final section of the book is entitled Man and Machine. Its two chapters discuss echocardiographic artifacts and how to optimize image quality by appropriately setting the echocardiography console controls.

Each chapter is followed by a bibliography and 10 to 20 self-assessment questions, the answers to which are provided at the end of the book. An extensive appendix comprises useful tables summarizing standard two-dimensional TEE views, normal values for cardiac dimensions, formulas for hemodynamic calculations, hemodynamic data for many common prosthetic heart valves, and current criteria for the echocardiographic grading of the severity of valvular heart disease. The book is not accompanied by a CD or DVD.

Appropriately for a highly visual subject matter, the book is well illustrated. Many excellent color drawings demonstrate cardiac anatomy and explain physical principles. The numerous echocardiographic images, many of them also in color, represent the anatomy or pathology under discussion superbly. As everybody who has written or lectured on echocardiographic subjects is aware, locating that perfect still image can require hours of searching, an investment of time and effort from which the authors of this text have clearly not shied. The (almost complete) absence of transthoracic echocardiographic images from this TEE textbook also deserves favorable mention.

Some practical guides are anything but. In contradistinction, A Practical Approach to Transesophageal Echocardiography does live up to its motto. The text reads easily and reflects extensive practical experience of the authors and editors with their subject matter. Most chapters include background information specifically relevant to perioperative echocardiography, step-by-step descriptions of the pertinent aspects of the TEE examination, and/or an outline of the author’s personal approach to the problem under discussion. Both the selection of topics and the content of individual chapters are balanced and clinically relevant. The temptation to include “everything there is to know” has generally been resisted.

No book review is complete without some quibbles: The number of literature references 5 yr old or less ranges widely (from 0 out of 39 to 10 out of 14); however, several chapters are notable for very few recent references, despite the publication of a number of relevant practice guidelines over the course of the past 5 yr. The chapter on TEE of the thoracic aorta does not discuss TEE in the evaluation of traumatic aortic injury. I also got the impression that some self-assessment questions might have benefited from more careful editing. These criticisms are minor, though, and should not detract from the credit due to the editors and contributors.

In summary, I found perusing A Practical Approach to Transesophageal Echocardiography  both instructive and enjoyable (despite only recently having prepared for the TEE recertification exam). The book is well organized and sufficiently comprehensive, yet concise enough to serve as an introductory text. The excellent illustrations, the practical perspective maintained throughout, and the useful appendix are particularly strong points. I will be recommending A Practical Approach to Transesophageal Echocardiography  to anesthesiology trainees and other students of perioperative echocardiography, and look forward to consulting my own copy in the future.

University of Washington, Seattle, Washington. jorgd@u.washington.edu