The Comatose Patient

Transesophageal echocardiography (TEE) is fast becoming the preferred diagnostic tool for evaluation of cardiac, pulmonary and vascular physiology, and pathology. It has been increasingly utilized for both cardiac as well as noncardiac surgeries. With increasing number of centers doing valve repairs as opposed to replacements, the use of TEE will continue to grow. As three dimensional TEE images get better and easier to obtain and interpret, the application of TEE will continue to expand. TEE is a category I indication for hemodynamic instability for non cardiac surgery according to ASA (American Society of Anesthesiologists) guidelines. ICU (Intensive Care Unit) care is leaning towards TEE for guidance towards appropriate care, especially in ventilated patients. The need for increasing echocardiographic experience has prompted the National Board of Echocardiography (www.echoboards .org) to develop standards and tests to evaluate echocardiographers As the number of providers performing and interpreting echocardiography increases, so does the need for books that cater to the wide array of echocardiographic needs. An ideal book would cover transthoracic, perioperative, and Intensive Care Unit TEE, as well as some aspects of pediatric TEE. Perioperative Echocardiography, edited by Kyung W. Park, MD is one such book. It provides TEE information simple enough to be understood by novices yet covers most of the details needed for more extensive comprehension. The book is written by multiple authors and has very good references, imparting credibility to the book. Explanations for various ways of obtaining and interpreting images are not rigid, and the book cautiously warns about possible pitfalls. Any cardiac book has to delve into physiology to explain complex pathology. This book provides a sufficient depth of explanations for this purpose. It also has an excellent epidemiological introduction to most chapters, citing many good references. It covers the entire spectrum of cardiac problems and supports acquisition of a knowledge base that allows readers to comprehend without additional references or texts. In addition, an understanding of physics is necessary to fully use the capabilities of TEE. The text provides a broad overview of basic TEE physics and calculations initially and, when readers have become accustomed, later chapters go into more detailed explanations and calculations. The impact of diastolic dysfunction has grown considerably in the last few years and is now recognized to be an important parameter in practice. The book provides an excellent chapter on diastology. The overview encompasses virtually all newer methods of determining diastolic dysfunction. The text also includes well-written chapters on intracardiac masses and noncardiac uses of TEE. Suggestions for further improvement of the book include better quality and colored pictures. As mentioned in the preface of the book, echocardiology is a visual art. While the images in this text provide good information, they could be improved by using glossy and colored pages. It is hard to make any comments on live images, as there was no CD-ROM, (Compact Disc) a supplement often included with texts on TEE. Three-dimensional echocardiography is becoming more and more common, and this book does not address it. In addition, new texts often offer questions and multiple choice answers either at the end of the book or in the CD-ROM (Compact Disc) format as a way of accessing knowledge gained from the book. This opportunity is not present in Perioperative Echocardiography. Overall, the book is an easy read and provides a wealth of information for both novice and experienced echocardiographers. In only 155 pages, it has managed to convey the most important aspects of TEE. The book should be considered a welcome addition to departmental libraries and those of individuals who are particularly interested in TEE.