Clinical Transesophageal Echocardiography: A Problem-Oriented Approach offers a unique perspective on intraoperative monitoring because it was written largely by anesthesiologists for anesthesiologists. The editors assume that the reader is a practitioner who is already familiar with the technique of transesophageal echocardiography. The technical aspects of echocardiography equipment or how to perform a routine examination are not discussed. Valvular and atrial disease are explored first, followed by chapters on cardiac evaluation in various clinical scenarios such as transplant surgery and hypotension.
Almost every chapter contains many pearls on the particular topic discussed, although each is written with a different style. Better editing could have made for a more even presentation. Likewise the quality of the pictures from one chapter to the next is inconsistent and the equipment used to obtain the illustrations is obviously quite variable, although descriptive characteristics of the type of machine used are not usually given.
A few chapters really shine, such as Chapter 8 on atheromatous aortic disease. This area is glossed over in many cardiology-based texts. However, the degree of disease in a patient's aorta is of great interest when the surgeon is considering whether and where to cannulate for bypass. Chapter 10 is surprisingly good in its discussion of wall-motion abnormalities. I expected this to be a topic that would require moving pictures such as a videotape or just plenty of clinical experience to grasp; however, the authors do a nice job of describing the pertinent features. The pictures in this chapter are quite helpful as well. Chapter 12 provides a description of left ventricular outflow obstruction and the surgery that is occasionally done to correct it. The discussion of the potential difficulties encountered with the repair and how to diagnose them is particularly helpful.
Overall, the book is a unique reference for intraoperative monitoring because it includes a review of such topics as echocardiographic evaluation of cardioplegia, intraoperative hypotension, catheters, and transplantation. The book is organized from the perspective of the anesthesiologist, with discussion of subjects that are either minimally touched on, or left out altogether in cardiology-based texts. While this should not be the first or only book on echocardiography in the anesthesiologist's library, it is a valuable addition to a more basic text and can provide useful information to the practitioner.