Anesth Analg 2005;101:1568-1569
© 2005 International Anesthesia Research Society
BOOK AND MULTIMEDIA REVIEWS
Section Editor:
Norig Ellison
Fundamental Applications of Transesophageal Echocardiography: A Society of Cardiovascular Anesthesiologists Monograph on DVD.
James E. Duckett, MD, and
Gordon H. Morewood, MD, FASE
Department of Anesthesiology, Bryn Mawr Hospital, Bryn Mawr, PA, ducks6{at}aol.com
Fundamental Applications of Transesophageal Echocardiography: A Society of Cardiovascular Anesthesiologists Monograph on DVD. Reeves ST, Shanewise JS, eds. Baltimore, MD: Lippincott Williams & Wilkins, 2005. ISBN 1-58255-761-6. $99.00.
Each year, the Society of Cardiovascular Anesthesiologists produces a multi-authored monograph focusing on a specific area of interest to their membership. This year the monograph has been produced for the first time as a DVD. The topic, transesophageal echocardiography, is well suited to this new format and the editors have obviously labored to take advantage of the many unique aspects of a computer-based publication.
The monograph is compatible with both Windows (2000, XP Professional) and Macintosh (OS X) operating systems with a Pentium II 550 or faster processor or a 550 MHz or faster processor, respectively. Both systems require at least 128 MB RAM and 1 MB hard disk space, as well as a DVD-ROM drive. For this commentary, the monograph was reviewed on appropriately configured Macintosh and Windows systems.
The editors are Drs. Scott Reeves and Jack Shanewise, both of whom are well-known educators in the field of cardiac anesthesiology. The monograph is composed of 17 chapters and there are 34 contributors representing the fields of cardiac anesthesiology, cardiothoracic surgery, and cardiology. As the contributors represent 17 different institutions, a broad sampling of current clinical approaches is presented. There are some inconsistencies in style from chapter to chapter, as well as some repetition of basic material, but overall the editors have produced a cohesive and easily readable package of information.
Once the DVD is loaded into the computer, the table of contents can be accessed, and the user can select one of the 17 chapters. Each chapter is self-contained; it is not necessary to review each chapter in sequence. The chapters begin with a text presentation, and relevant figures, tables, and video loops are then hyperlinked to the text. Once a figure is reviewed, return to the text is rapid.
Most chapters begin with a brief review of the topic, emphasizing published data regarding the natural history of the condition under discussion, the results of various treatment modalities, and then follow with a discussion of the role of TEE in diagnosis and surgical decision-making. Some chapters cover broad topics such as "Indications and Outcomes" or "Hemodynamics." However, in keeping with the editors’ stated goals, focus on specific disease states encountered in clinical practice or tackle specific controversial issues in echocardiography (e.g., mechanisms and treatment of ischemic mitral regurgitation, moderate aortic stenosis in patients undergoing coronary artery bypass). Many of the chapters make effective use of case presentations to illustrate specific clinical problems. While much of the monograph is devoted to discussion of problems commonly encountered by most cardiac anesthesiologists, there is also coverage of less common problems, such as congenital heart disease in adults, ventricular assist devices, and employment of TEE during treatment of atrial or ventricular septal defects with transvenous occlusive devices.
As with previous SCA monographs, this work is not meant to be a comprehensive step-wise discussion of the topic selected. Thus, it would not be an appropriate choice for the novice wishing an introduction to clinical echocardiography. However, any clinician with at least a working knowledge of echocardiography will find much worthwhile information in this multidisciplinary text.
Most of the shortcomings of the monograph are technical in nature. Many of the video clips are slow to load (up to 2 minutes on the Windows system). Exacerbating this problem is the fact that text and graphics windows cannot be viewed simultaneously, leaving the reader staring at a blank screen waiting for the video. Allowing readers to continue reading the text while loading video images in a separate window would be a significant improvement.
The text formatting is extremely basic and no distinction (font, size, color) is made between major and minor headings. In addition, the reader must "flip" from one page to the next rather than "scroll" as is common in software applications today. The net effect of these two drawbacks is a disjointed reading experience, and it is occasionally difficult to follow the narrative flow from one section of text to the next within a given chapter.
Finally, the resolution of the tables is poor overall, and many with small print are close to being illegible. This is a peculiar problem for a work produced as a DVD, where memory (and thus image resolution) was presumably in abundance.
Despite these minor flaws, this year’s monograph is a worthwhile addition to the library of all echocardiographers who practice in the perioperative environment. It deserves to be read, discussed, and debated and will hopefully serve as an example for future publications on perioperative echocardiography.
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