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Congenital Heart Disease after Surgery: Benefits, Residua, Sequelae
REVIEW OF RECENT BOOKS
Congenital Heart Disease after Surgery: Benefits, Residua, Sequelae Edited by M a y Allen Engle, M . D . , and Joseph K . Perlofi, M . D. New York, Yorke, 1983 419 pp. illustrated, $40.00
Reviewed by Thomas L. Spray, M . D . Despite dramatic improvements in the results of surgical treatment of congenital heart disease, the ideal of total correction or complete cure continues to be achieved rarely. Therefore, as more children survive past infancy, the long-term effects of operation for congenital heart defects are of increasing importance. Drs. Engle and Perloff have attempted in this volume to examine the long-term results of surgical therapy as they affect the care of patients with postoperative congenital heart disease. They have admirably succeeded in their goal. Quite appropriately, the editors have dedicated the volume to Dr. Helen B. Taussig, who is also a contributing author. The book is divided into six parts. Part I consists of a survey of the common cardiac malformations and includes Dr. Taussig’s exposition of her theory that the common congenital cardiac malformations are in fact primeval hearts with genes that have remained in the mammalian genetic pool. An additional chapter on a 100% follow-up of 1,000 consecutive children with congenital heart disease gives excellent long-term survival data with and without operation for perspective. Part I1 includes four chapters on the long-term follow-up of noncyanotic congenital heart disease. The common and surgically correctable lesions are covered here, with emphasis on ventricular septal defect, atrial septal defect, patent ductus arteriosus, pulmonary stenosis, and coarctation of the aorta. These defects were the earliest that were surgically treatable; therefore, major follow-up data are available. General considerations of employability and insurability are included. A chapter from the Mayo Clinic on isolated coarctation repair reports a large proportion of patients with late hypertension and stresses the need for early operation to prevent this complication. A chapter on the valvular residua and sequelae after repair of congenital heart defects is also included; the late tendency for aortic valvotomy to result in insufficiency or restenosis is emphasized. In Part 111, the postoperative concerns in patients with cyanotic congenital heart disease are described. There are chapters on postoperative pulmonary vascular disease, problems with
500
pulmonary stenosis or insufficiency after tetralogy repair, and late follow-up of the modified Mustard operation for transposition of the great vessels. An interesting chapter by Dr. McGoon on the long-term effects of prosthetic materials is particularly relevant. Part IV analyzes the problems of postoperative function in five chapters, which include comments on the sequelae of atriotomy on the endocardium and conduction system by Drs. Bharati and Lev, and considerations of effects of operation on the coronary arteries and myocardium by the same authors. These concerns are conspicuously absent in most volumes dealing with congenital heart disease. Important chapters on the electrophysiological residua and sequelae and the pathogenesis and time course of the development and regression of increased ventricular mass are also presented. Dr. Thomas Graham reports on the long-term ventricular performance in adults after congenital heart operation. In Part V, psychosocial aspects of congenital heart disease are presented with comments on the quality of life and important chapters on the outcome of pregnancy in women with and without surgical treatment. These are aspects of long-term follow-up that are often given little attention and are particularly valuable. Finally, in Part VI, epilogues by a pathologist, a pediatric cardiologist, and a cardiac surgeon serve to empasize the remarkable progress that has been made and the optimistic prediction of progress for the future. Although there is some repetition of subject matter in this text (as is common in multiauthored symposia), the amount of data presented is substantial and well organized. The material presented here is not readily obtainable in other texts and is of increasing importance for all physicians who deal with congenital heart disease. Although the criticism can be made that the follow-up data d o not include information on the newer techniques and that, therefore, results may change and improve with time, this will hopefully be only one of a series of monographs that will summarize the collected results as more complex operations done at increasingly earlier ages create new populations of patients with postoperative congenital heart disease. Although thought-provoking for the medical student and resident, this outstanding and affordable volume will be of greatest interest to the cardiologist and cardiac surgeon. St. Louis, M O
Congenital Heart Disease after Surgery: Benefits, Residua, Sequelae Edited by M a y Allen Engle, M . D . , and Joseph K . Perlofi, M . D. New York, Yorke, 1983 419 pp. illustrated, $40.00
Reviewed by Thomas L. Spray, M . D . Despite dramatic improvements in the results of surgical treatment of congenital heart disease, the ideal of total correction or complete cure continues to be achieved rarely. Therefore, as more children survive past infancy, the long-term effects of operation for congenital heart defects are of increasing importance. Drs. Engle and Perloff have attempted in this volume to examine the long-term results of surgical therapy as they affect the care of patients with postoperative congenital heart disease. They have admirably succeeded in their goal. Quite appropriately, the editors have dedicated the volume to Dr. Helen B. Taussig, who is also a contributing author. The book is divided into six parts. Part I consists of a survey of the common cardiac malformations and includes Dr. Taussig’s exposition of her theory that the common congenital cardiac malformations are in fact primeval hearts with genes that have remained in the mammalian genetic pool. An additional chapter on a 100% follow-up of 1,000 consecutive children with congenital heart disease gives excellent long-term survival data with and without operation for perspective. Part I1 includes four chapters on the long-term follow-up of noncyanotic congenital heart disease. The common and surgically correctable lesions are covered here, with emphasis on ventricular septal defect, atrial septal defect, patent ductus arteriosus, pulmonary stenosis, and coarctation of the aorta. These defects were the earliest that were surgically treatable; therefore, major follow-up data are available. General considerations of employability and insurability are included. A chapter from the Mayo Clinic on isolated coarctation repair reports a large proportion of patients with late hypertension and stresses the need for early operation to prevent this complication. A chapter on the valvular residua and sequelae after repair of congenital heart defects is also included; the late tendency for aortic valvotomy to result in insufficiency or restenosis is emphasized. In Part 111, the postoperative concerns in patients with cyanotic congenital heart disease are described. There are chapters on postoperative pulmonary vascular disease, problems with
500
pulmonary stenosis or insufficiency after tetralogy repair, and late follow-up of the modified Mustard operation for transposition of the great vessels. An interesting chapter by Dr. McGoon on the long-term effects of prosthetic materials is particularly relevant. Part IV analyzes the problems of postoperative function in five chapters, which include comments on the sequelae of atriotomy on the endocardium and conduction system by Drs. Bharati and Lev, and considerations of effects of operation on the coronary arteries and myocardium by the same authors. These concerns are conspicuously absent in most volumes dealing with congenital heart disease. Important chapters on the electrophysiological residua and sequelae and the pathogenesis and time course of the development and regression of increased ventricular mass are also presented. Dr. Thomas Graham reports on the long-term ventricular performance in adults after congenital heart operation. In Part V, psychosocial aspects of congenital heart disease are presented with comments on the quality of life and important chapters on the outcome of pregnancy in women with and without surgical treatment. These are aspects of long-term follow-up that are often given little attention and are particularly valuable. Finally, in Part VI, epilogues by a pathologist, a pediatric cardiologist, and a cardiac surgeon serve to empasize the remarkable progress that has been made and the optimistic prediction of progress for the future. Although there is some repetition of subject matter in this text (as is common in multiauthored symposia), the amount of data presented is substantial and well organized. The material presented here is not readily obtainable in other texts and is of increasing importance for all physicians who deal with congenital heart disease. Although the criticism can be made that the follow-up data d o not include information on the newer techniques and that, therefore, results may change and improve with time, this will hopefully be only one of a series of monographs that will summarize the collected results as more complex operations done at increasingly earlier ages create new populations of patients with postoperative congenital heart disease. Although thought-provoking for the medical student and resident, this outstanding and affordable volume will be of greatest interest to the cardiologist and cardiac surgeon. St. Louis, M O