Congenital heart disease. Correlation of pathologic anatomy and angiocardiography

1~s SUKKES DB L'AoKTE 'I‘HOKA~IQUE. lZ?~um CLINIQW ET EXPEHIMENTALE. By Fernand Lantin, M.I)., Brussels, 1963, Editions Arscia. 171 pages. This book, published in French in 1963, presents clinical observations and experimental studies of complications, particularlv mycotic aneurysm and rupture of the suture I&, after opcratioll on the thoracic aorta. The importance of the anatomic distribution of the vasa vasorum in the aorta is emphasized. The incidence of mycotic aneurysm or rupture is shown to be directly proportional to the degree of resection of the ndventitia from the aortic wall or its traumatiwation by vascular clamps. E.uperimentally, the incidence ol this complication after resection of the advcntitia using sterile or unsterile sutures to close aortotomies was about 10 per cent. No complications were observed if the adventitia was left intact. Because the incidence of complications is greater in the ascending aorta than in the descending aorta, the following was proposed as the possible etiology: (1) Resection of the adventitia from the ascending aorta removes more vaaa ~asorum than from elsewhere in the aorta, hecactse of the location of the origin and anatomic distribution of these vessels. (2) The ascending aorta is subjected to more dynamic. pressure and tension than is the descending aorta. Guided by experimental results and clinical cxperiellrc, particularly that of Professor Bram, of L&den, the author makes the following conelusions: (1) The advcntitia must be left intact if vascular complications are to be prevented. (2) Secrosis of the media develops around the stitches of the anastomosis. It is of importance, therefore, that the sutures be placed sufficientI) far apart and not too close to the margin of the incision. (3) A longitudinal anastomosis in the ascending aorta is best oversewn with double sutures. (4) After an operation involving an aortic anastomosis. the symptoms that suggest II myrotir aneurysm are fever, recurrent arterial enlbolism, and manifestations of sepsis. A secondary operation to remove infected material must Ire conl-idered.

THK I)OCTOK AS A WIWISS. Edited by ~Viltiam J. Curran, LLM., S.M.Hyg., Director, I,aw-Medicine Institute, Boston University, Boston, Mass. Second edition, Philadelphia, 1965, IV. B. Saunders Company, 196 pages. Price $5.75. This small book should interest all ph+cians. It is clearly written and defines some of the important problems which confront the physician in court. Among the subjects discussed are preparation for trial, what makes a good medical witness, privileges and obligations of the doctor-witness, opinion e\-idence and expert testimony, direct and c~ross-e~a!lliliatio~i, compensation, and others. This useful book is recommended to at1 physicans and students of medicine.

CONGBNITAL HEAKT DISEASE. COKKELATIOK OF PATHOLO(X APMTOMV AND AN(;IOCAKDIO(;XAI'H\., Volumes I and II. Edited by Jesse E. Edwards, M.D., I,ewis S. Carey, M.D., Henry N. Neufeld, M.D., and Richard G. Lester, M.D., Philadelphia, 1965, \V. B. Saunders Company, 890 pages. Price $45 per set. ‘l‘hesc two volumes b>. Edwards and his coauthors are essentially an atlas of excellent illustrations and legends supported by a brief text. Diagrams are used to explain lesions and the associated hemod>-namic disturbances. Koentgenograms, angiocardiograms, and photomicrograms are illustrated freely. Dr. Edwards and his associates have been interested for many years in the clinical pathology of patients with congenital heart disease, and these two volumes summarize very well their concepts and studies. Even though these books are more of the nature of a reference work and an atlas, they should be made readily available to internists, cardiologists, oatholoeists. cardiac surgeons, and medical st;dents. -The average student and physician will find these volumes to be of great value as a reference work. The brief clinical data presented with the cases increase the value of the books for training purposes in clinical cardiology.

A PKI~R OF CARDIAC CATHETE:KIZATION. By C. Kory, Theolilos J. ‘I‘sagaris, and Rodrigo Bustamente, Springfield, Ill., 1965, Charles Thomas, 114 pages. Price $7.50.

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This slim volume was evolved by the authors as a result of experiences in teaching cardiac catheterization to medical students, interns, and residents. The book is well designed C. to serve as an aid in the instruction of physicians-in-training with regard to commonly used cardiac diagnostic laboratory methods and their interpretation. The text IS illustrated with 74 roentgenograms and intracardiac pressure recordings or diagrams, which are, with few exceptions, clear and well chosen. The bibliography is selective rather than exhaustive, but certainly adequate for the intended audience. In addition to a discussion of cardiac and great-vessel pressure recordings, there is a presentation of methods of cardiac-output measurement, indicator-dilution curves, angiorardiography, and the use of the hydrogen electrode, dye curves, and inhaled foreign gases in the detection of right-to-left and left-to-right shunts. The reviewer has successfully employed an earlier version of this material in the introductory training of postgraduate fetlows in cardiology. This volume is recommended as fin aid in the instruction of medical students and house staff. Since it does not discuss indications, applications, or limitations of these diagnostic tests, it should not be employed without supplemental instruction. Because of the intentionally restricted treatment of the topic, the book will not appeal to most physicians in practice.