Perrino AC, Reeves ST: A Practical Approach to Transesophageal Echocardiography.

A Practical Approach to Transesophageal Echocardiography is a new contribution from anesthesiologists, with the help and the backup of a few cardiologists, to teach transesophageal echocardiography (TEE) to their colleagues.

The book has the format of a field guide and is intended to provide a quick, albeit extensive, overview of TEE to students. The physical principles of ultrasound techniques (two-dimensional imaging and Doppler velocimetry) are briefly but clearly explicated with the help of numerous figures. Normal TEE examination is described step by step and is illustrated extensively. The various applications of TEE during cardiac surgery are covered: from the preoperative study of valvular diseases to the intraoperative assessment of mitral valve repair and the postoperative examination of prosthetic valves.

Anesthesiologists working in cardiac surgery are undoubtedly better off if they can use and interpret TEE. The vision of the heart provides them with invaluable information to guide intraoperative management as well as with a unique tool to tell the surgeon whether his repair is satisfactory.

The chapter about TEE in the intensive care unit (ICU) is very small in comparison. I regret that the benefit of echo for the understanding of hemodynamic instability has not been more thoroughly emphasized since this is the main reason for having an ultrasound machine in every ICU. The importance of transthoracic examination is somewhat downplayed, although TEE remains extremely useful in ICU patients. One can also disagree with the presentation that opposes TEE and pulmonary artery catheterization. Both methods are useful in the ICU: echo is a more potent diagnostic tool in situations of hemodynamic instability but it is less suited for long-term monitoring.

No doubt all residents and fellows in anesthesiology who are interested in cardiac surgery will find in this book the basics to better understand and realize a TEE examination!