Perioperative Transoesophageal Echocardiography: a Companion to Kaplan’s Cardiac Anesthesia

Abstract

During the last 30 yr, the role of transoesophageal echocardiography (TOE) in the perioperative care of cardiac surgical patients has become firmly established and is now the standard of care for a wide range of procedures. This substantial text, with the main bulk of the contributors emanating from either the USA or Canada, covers a broad range of topics related to this indispensible imaging modality. The book begins with the 20 standard transoesophageal echocardiographic views as outlined by the landmark consensus paper published jointly by the ASA and the Society of Cardiovascular Anesthesiologists (SCA) in 1996. After this fairly generic opening, the next 11 chapters cover the basic principles and knowledge required of an echocardiographer. The basics of ultrasound in the construction of two-dimensional images and spectral Doppler are explained, plus a short section on imaging artifacts and pitfalls that perhaps deserved a more lengthy discussion. These initial chapters also go on to examine cardiac anatomy, fluid mechanics, and cardiac physiology and to introduce the concepts of quantitative and semi-quantitative echocardiography. Although this section of the book is comprehensive, the explanation of some fairly difficult concepts is not always clear and can be a little repetitive. However, the textbook comes into its own in later chapters with excellent descriptions of cardiac pathology and the intraoperative conduct of the TOE examination as it relates to the surgery for various conditions. The chapters on aortic and mitral valve pathology are comprehensive, well illustrated and incredibly informative. There are interesting and detailed chapters on cardiomyopathies, endocarditis, pericardial disease, and adult congenital heart disease that contain a level of detail and practical knowledge not seen in many other books on this topic. The text is up to date with recent advances in echocardiography, including short sections on both speckle tracking and cardiovascular flow visualization. One of the great strengths of the book is the large library of video clips that follow the chapters. This includes many three-dimensional echo images that complement the text and provide examples illustrating the degree of information one may obtain with TOE. The final sections of the book are pertinent to clinicians responsible for managing an echocardiography department. The later chapters focus on maintaining the quality of perioperative echocardiography services and administrative aspects of delivering a TOE service. This book is not primarily aimed at anaesthetists starting their training in TOE or for those preparing to sit the British Society of Echocardiography examination. This book is much more designed to assist clinicians with a greater degree of experience, providing a wealth of information on the conduct of TOE in the perioperative setting for a wide variety of pathologies and cardiac surgical procedures. In this role it is a powerful learning tool.