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Over the past 60 years, echocardiography has become the most important and widely used imaging modality in cardiovascular medicine. And even though the core technology still relies on the same fundamental physical properties of reflected waves, the variety of innovations and applications that have evolved to enable sophisticated imaging of cardiac structure and function in three-dimensional space is astonishing. The underlying principles are simple enough: ultrasound waves are sent from a transducer, then the reflected waves are analyzed in two domains: a time-intensity domain (to characterize the structure) and a frequency-shift domain (to assess the speed of motion). With modern transducer technology and computer processing speeds, echo images have greater spatial and temporal resolution than ever, and the usefulness of echo across all forms of cardiovascular disease is without parallel. One cannot be a cardiovascular specialist without an in-depth knowledge of echocardiography.

This volume goes a long way to addressing this need. While transthoracic echocardiography is the initial approach for the majority of clinical conditions, transesophageal echocardiography (TEE) remains essential since its introduction in the 1980s, as it provides images with much higher resolution, particularly in the cardiac base and in technically difficult studies. This is crucial in the care of the critically ill patient or during cardiac interventions, where diagnostic accuracy is paramount. Drs. Joseph P. Mathew, Alina Nicoara, Chakib M. Ayoub, and Madhav Swaminathan lay a solid foundation for understanding the intricacies of transesophageal echocardiography, from the basic principles of ultrasound to various clinical applications of TEE, including its role in the critically ill, in monitoring heart function in the operative theater, and in evaluating the immediate results of cardiac procedures.

This third edition of Clinical Manual and Review of Transesophageal Echocardiography accomplishes the difficult task of speaking with ease to both the novice and the expert, while updating the text of their second edition to include recent improvements in the field, inclusive of strain imaging. The authors cover all the novel uses of three-dimensional imaging with a focus on those that apply to valvular heart surgery and the critical care setting, offering wisdom accumulated through long experience. The illustrations and instructional videos included with this volume reflect the authors' deep expertise in both the technique and the teaching of TEE; questions at the end of chapters and the TEE practice exams will help prepare those who intend on taking certification examinations. This third edition also incorporates a superb online supplement with instructional videos.

In short, this clinical manual and review of transesophageal echocardiography will enlighten the reader and promote the expert application of transesophageal echocardiography in the care of high-risk patients.

William A. Zoghbi MD, FASE, MACC

Professor and Chair, Department of Cardiology

Methodist DeBakey Heart & Vascular Center

Houston Methodist Hospital

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