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Chairman; Department of Anesthesiology; St. Luke's-Roosevelt Hospital Center; New York, NY
Atlas of Multiplane Transesophageal Echocardiography. St John Sutton MG, Maniet AR. New York: Martin Dunitz, 2004. ISBN 1-85317-217-0. 935 pp. $ 529.00.
This two-volume atlas is divided into 10 chapters. Volume 1 covers the normal transesophageal echocardiographic (TEE) examination, the pathology of native valves, and the pathology of the aorta and pulmonary artery. Volume 2 discusses the evaluation of the cardiac chambers and pericardium, prosthetic valves, cardiac masses and tumors, congenital heart disease (in adults), and specific applications of multiplane TEE (mostly perioperative). Each chapter follows a similar format, beginning with normal structures and function followed by descriptions of abnormalities of structures and function. They each conclude with a large collection of images that are labeled "case studies" by the authors. In addition to echo images, the book also contains a large number of pictures of anatomic specimens, original drawings, and surgical photographs.
In the preface, the authors identify two aims for the atlas: 1) to provide medical students, anesthesiologists, cardiac surgeons, and cardiologists with a concise but in-depth analysis of cardiac imaging drawn from the authors’ broad experience; and 2) to serve as a reference of diagnostic examples of cardiac pathology for physicians who practice TEE. The authors are fully successful in achieving the second aim. The experienced echocardiographer will enjoy browsing through the hundreds of echo images that display a wide variety of cardiovascular pathologies. Chapters that deserve special mention are those dedicated to prosthetic valves and congenital heart disease. Most currently available prosthetic valves are displayed in multiple color pictures. In addition, many echo images are displayed that show pathologic findings in patients with prosthetic valves (46 case studies). In the chapter on adult congenital heart disease, artistic renderings of cardiac pathology and surgical procedures are combined with numerous high-quality echo images. Unfortunately, this chapter also contains an incomprehensible flaw for a book of this cost. The page count jumps from page 796 to page 845 and then back from page 868 to page 821. In the process, congenital case studies 9.16 to 9.28 are omitted, while pages 845–868 are rendered twice. For a price of more than $500 one would expect more careful editing.
The above-mentioned flaw is only one of many that will confront the student of echocardiography who tries to proceed, page by page, through these books. Each chapter indeed begins with a short introduction, but in their conciseness, the introductory remarks will leave many novice readers clueless as to their meaning. As an example, the chapter on mitral stenosis refers to the Bernoulli equation, yet nowhere will the reader discover what P1, P2, and Vmax represent. On page 60, the reader will find short-axis images of mitral valve motion in normals and in type I, II, and III Carpentier classification. There is no explanation, however, as to what this classification means (the first mention of the Carpentier classification is on page 73). Neither is there any explanation in the figure legend as to what abnormalities the reader should try to discern. Unfortunately, the same is true for many of the case studies. None of the legends in the case studies refer to the text of the chapters. Numerous arrows, markers, and lines on the echo images are not associated with any explanations. Non sequiturs like ". . .this or that can be measured . . ." are in abundance, without any clarification or any attempt to provide the actual measurements. Didactic pointers are often absent. In choosing not to use the standard American Society of Echocardiography nomenclature for multiplane TEE, the authors have done themselves and the readers a great disservice; consistency has didactic value.
In summary, with its numerous high-quality echo images, the book will find its place as a reference work in many departmental libraries. However, novices who attempt to broaden their knowledge of transesophageal echocardiography through the study of this book are likely to find it a frustrating experience. For $500 they should be able to find educational materials that are more user friendly.
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