- Email: [email protected]
Echocardiography in coronary artery disease
International Elsevier
CARD10
Journal of Cardtologv,
255
29 (1990) 255-251
01166
Book Reviews
Atlas of Cardiothoracic L.H.
Edmunds
Lea & Febiger, 287 pp., E85.94,
Surgery
Jr, W.1. Norwood Philadelphia ISBN
and
D.W.
& London,
Low
1990;
O-8121-1224-5
Of the various atlases of surgical procedures performed on the heart and lungs which have appeared recently. this one, in my opinion, is the best. Although the authors claim that no atlas can be truly comprehensive, theirs must come very close, addressing not only the incisions needed to gain access to the chest, and the various operations performed for acquired and congenital diseases of the heart and great vessels, but other mediastinal procedures. It is, therefore, an all-encompassing guide for those who operate within the chest. The authors are all from the University of Pennsylvania. and an added advantage is that the excellent and clear line drawings were prepared by Dr Low, who is now a plastic surgeon at the University. Drs Edmunds and Norwood need no such introduction. The layout is first-class. with brief paragraphs of text on the left hand page, together with descriptions of staged procedures. complementing the beautiful drawings on the right hand page. Taste varies markedly amongst those who study artistic renditions of surgical procedures. Dr Low’s drawings appeal to me, and show with exquisite clarity the important details of anatomy required by the surgeon. It could, of course, be argued that, nowadays. this type of information is better provided by direct photography. Indeed, better and better photographs are now being obtained during cardiac surgery. But artistic representation is the traditional format, and this Atlas now sets the gold standard. It is not, however, without its deficiencies. Dr Norwood is certainly a busy man. but someone should have read the proofs to correct “Epstein’s anomaly”! It would have helped to have shown the site of the conduction tissues. I hope Dr Norwood doesn’t really incise the right atrium as shown on p. 151, because. if so, his suture line goes right through the sinus node! Much of the anatomical description reflects American prejudices, but this is, per0167-5273/W/$03.50
0 1990 Elsevier Science
Publishers
haps, to be expected. It is particularly encouraging to see that such things as the trifoliate nature of the left atrioventricular valve in hearts with deficient atrioventricular septation are now achieving recognition. Overall. therefore, this is a superb atlas. It can be warmly recommended to all who operate within the chest, particularly those who are still in training. At just over f85. it is a present day bargain. Dept. of Paediatrics National Heart & Lung Institute London. U.K.
Echocardiography Editor:
Richard
Futura
Publishing
441 pp.:
$86:
Robert
H. Anderson
*
in Coronary Artery Disease E. Kerber Co, Mt Kisco.
JSBN
New
York,
1988:
O-87993-325-9
Is a whole book on echocardiography in coronary artery disease justifiable? The answer is an unqualified yes. Of all the imaging techniques in cardiology, ultrasound is the one whose development has been the most spectacular, in both the literal and metaphorical sense. The primitive Polaroid snap-shots of a rheumatic mitral valve or pericardial effusion have been eclipsed first by M-mode chart recordings which were potentially misleading in coronary arterial disease, and now by crosssectional video recordings which yield reasonable dynamic images of the left ventricle. Doppler echocardiography then permitted easier identification of the mechanical complications of myocardial infarction, such as mitral regurgitation and ventricular septal rupture. Colour flow Doppler has made interpretation easier whilst small transducers have paved the way for trans-
* European
B.V. (Biomedical
Editor,
Division)
Inrernational
Journal of Cardiology
256 oesophageal and intra-operative echocardiography. These latter developments are well discussed in this book. What are the current problems and where do we go next? If you want to know the answers to these questions, then you had better buy or steal the book. Borrowing is not good enough because you will need to refer back to it. Today’s theoretical problems, for example the quantification of left ventricular function, are generally well discussed, although some of the practical aspects such as the difficulty of obtaining adequate images during exercise, are rather glossed over. Some of the discussion is necessarily technical but most of the book is easy to understand, well written and well illustrated. There are multiple authors for most chapters, but despite this the style is uniform and reduplication is rare. If you want to look up a subject you will find both it and the references, for example, the fate of left ventricular thrombi, the detection of coronary atherosclerosis by the trans-thoracic approach, and echocardiography in Kawasaki disease and other coronary abnormalities in children. Doppler echocardiography can, of course, be performed by one technician and is relatively cheap. The immediate dynamic image can be repeated, endlessly. These obvious merits of ultrasound may well prompt you to turn first to the chapters devoted to the serial assessment of left ventricular function in acute myocardial infarction. You will not be disappointed. Experimental infarcts do expand immediately and in man the process may be very rapid; large infarcts go on expanding whereas smaller ones may shrink. Already we know more about the acute effects of acute myocardial infarction in man than we do from using other imaging techniques. Echocardiography must be the most promising technology for assessing the effect of treatment on left ventricular function. The topics of the final chapters including automatic edge detection, tissue characterisation and contrast echocardiography indicate how the future coronary care unit may find on-line ultrasound an indispensable adjunct to electrocardiographic monitoring. The future is exciting, not only for clinical practice, but also for research; intra-operative epicardial echocardiography can increase our understanding of coronary atherosclerosis; the intra-coronary Doppler catheter permits measurement of coronary blood flow velocity. Surprisingly, this book does not include discussion of intra-coronary echocardiography which has highlighted the importance of “tubular” atherosclerosis and which is not being used to study the effects of angioplasty; but you cannot have everything. There is little excuse for any new medical textbook
nowadays. Most are obsolete by the time they reach your shelves. But this is an exception. There is a place for this particular “state of the art compendium”. Finally, there remains the problem of the book’s dedication to Linda. This happens to be the name of both the editor’s wife (a Professor in the Liberal Arts) and his clinical laboratory technologist. He has chosen the words “Dalla sua pace la mia dipende”, which is arguably the finest tenor aria ever written. If Kerber can sing that, both Lindas must enjoy peace of mind and a great deal more.
Papworth Hospital Cambridge, U.K.
Consultant
M.C. Petch Cardiologist
Long-term Management of Patients after Myocardial Infarction (Developments in Cardiovascular Medicine) Editors: C.T. Kappagoda and P.V. Greenwood Martinus Nijhoff Publishing, Boston/ Dordrecht/ Lancaster, 1988; 244 pp.; Dfl. 125, $50, E34.50; ISBN O-89838-352-8 It is now well established that the prognosis after recovery from an index acute myocardial infarction is determined by many variables, but particularly age and the degree of left ventricular damage. There are many ways, some simple, others complex, of attributing likely risks to individual survivors, even those who appear resolutely symptom-free and whose “risk” is only exposed by exercise testing, Holter monitoring, or coronary angiography. As for post-infarct management the questions are endless - perhaps some are answered in this volume? After an introduction by Nanette Wenger, there follow four sections - patterns of coronary arterial disease and survival, assessment of function, therapeutic options, and future trends. Rather than confine itself to the survivors of infarction, however, there is also discussion on pre-hospital demography, in-hospital acute intervention (both medical and surgical), and of various ways in which risk stratification can be applied. Unfortunately there is precious little discussion of controlled data in which risk, once assessed, can be modified, except by use of beta-adrenoceptor blocking drugs. From the general, the text moves to the particular problems - when (not if) coronary angiography should
CARD10
Journal of Cardtologv,
255
29 (1990) 255-251
01166
Book Reviews
Atlas of Cardiothoracic L.H.
Edmunds
Lea & Febiger, 287 pp., E85.94,
Surgery
Jr, W.1. Norwood Philadelphia ISBN
and
D.W.
& London,
Low
1990;
O-8121-1224-5
Of the various atlases of surgical procedures performed on the heart and lungs which have appeared recently. this one, in my opinion, is the best. Although the authors claim that no atlas can be truly comprehensive, theirs must come very close, addressing not only the incisions needed to gain access to the chest, and the various operations performed for acquired and congenital diseases of the heart and great vessels, but other mediastinal procedures. It is, therefore, an all-encompassing guide for those who operate within the chest. The authors are all from the University of Pennsylvania. and an added advantage is that the excellent and clear line drawings were prepared by Dr Low, who is now a plastic surgeon at the University. Drs Edmunds and Norwood need no such introduction. The layout is first-class. with brief paragraphs of text on the left hand page, together with descriptions of staged procedures. complementing the beautiful drawings on the right hand page. Taste varies markedly amongst those who study artistic renditions of surgical procedures. Dr Low’s drawings appeal to me, and show with exquisite clarity the important details of anatomy required by the surgeon. It could, of course, be argued that, nowadays. this type of information is better provided by direct photography. Indeed, better and better photographs are now being obtained during cardiac surgery. But artistic representation is the traditional format, and this Atlas now sets the gold standard. It is not, however, without its deficiencies. Dr Norwood is certainly a busy man. but someone should have read the proofs to correct “Epstein’s anomaly”! It would have helped to have shown the site of the conduction tissues. I hope Dr Norwood doesn’t really incise the right atrium as shown on p. 151, because. if so, his suture line goes right through the sinus node! Much of the anatomical description reflects American prejudices, but this is, per0167-5273/W/$03.50
0 1990 Elsevier Science
Publishers
haps, to be expected. It is particularly encouraging to see that such things as the trifoliate nature of the left atrioventricular valve in hearts with deficient atrioventricular septation are now achieving recognition. Overall. therefore, this is a superb atlas. It can be warmly recommended to all who operate within the chest, particularly those who are still in training. At just over f85. it is a present day bargain. Dept. of Paediatrics National Heart & Lung Institute London. U.K.
Echocardiography Editor:
Richard
Futura
Publishing
441 pp.:
$86:
Robert
H. Anderson
*
in Coronary Artery Disease E. Kerber Co, Mt Kisco.
JSBN
New
York,
1988:
O-87993-325-9
Is a whole book on echocardiography in coronary artery disease justifiable? The answer is an unqualified yes. Of all the imaging techniques in cardiology, ultrasound is the one whose development has been the most spectacular, in both the literal and metaphorical sense. The primitive Polaroid snap-shots of a rheumatic mitral valve or pericardial effusion have been eclipsed first by M-mode chart recordings which were potentially misleading in coronary arterial disease, and now by crosssectional video recordings which yield reasonable dynamic images of the left ventricle. Doppler echocardiography then permitted easier identification of the mechanical complications of myocardial infarction, such as mitral regurgitation and ventricular septal rupture. Colour flow Doppler has made interpretation easier whilst small transducers have paved the way for trans-
* European
B.V. (Biomedical
Editor,
Division)
Inrernational
Journal of Cardiology
256 oesophageal and intra-operative echocardiography. These latter developments are well discussed in this book. What are the current problems and where do we go next? If you want to know the answers to these questions, then you had better buy or steal the book. Borrowing is not good enough because you will need to refer back to it. Today’s theoretical problems, for example the quantification of left ventricular function, are generally well discussed, although some of the practical aspects such as the difficulty of obtaining adequate images during exercise, are rather glossed over. Some of the discussion is necessarily technical but most of the book is easy to understand, well written and well illustrated. There are multiple authors for most chapters, but despite this the style is uniform and reduplication is rare. If you want to look up a subject you will find both it and the references, for example, the fate of left ventricular thrombi, the detection of coronary atherosclerosis by the trans-thoracic approach, and echocardiography in Kawasaki disease and other coronary abnormalities in children. Doppler echocardiography can, of course, be performed by one technician and is relatively cheap. The immediate dynamic image can be repeated, endlessly. These obvious merits of ultrasound may well prompt you to turn first to the chapters devoted to the serial assessment of left ventricular function in acute myocardial infarction. You will not be disappointed. Experimental infarcts do expand immediately and in man the process may be very rapid; large infarcts go on expanding whereas smaller ones may shrink. Already we know more about the acute effects of acute myocardial infarction in man than we do from using other imaging techniques. Echocardiography must be the most promising technology for assessing the effect of treatment on left ventricular function. The topics of the final chapters including automatic edge detection, tissue characterisation and contrast echocardiography indicate how the future coronary care unit may find on-line ultrasound an indispensable adjunct to electrocardiographic monitoring. The future is exciting, not only for clinical practice, but also for research; intra-operative epicardial echocardiography can increase our understanding of coronary atherosclerosis; the intra-coronary Doppler catheter permits measurement of coronary blood flow velocity. Surprisingly, this book does not include discussion of intra-coronary echocardiography which has highlighted the importance of “tubular” atherosclerosis and which is not being used to study the effects of angioplasty; but you cannot have everything. There is little excuse for any new medical textbook
nowadays. Most are obsolete by the time they reach your shelves. But this is an exception. There is a place for this particular “state of the art compendium”. Finally, there remains the problem of the book’s dedication to Linda. This happens to be the name of both the editor’s wife (a Professor in the Liberal Arts) and his clinical laboratory technologist. He has chosen the words “Dalla sua pace la mia dipende”, which is arguably the finest tenor aria ever written. If Kerber can sing that, both Lindas must enjoy peace of mind and a great deal more.
Papworth Hospital Cambridge, U.K.
Consultant
M.C. Petch Cardiologist
Long-term Management of Patients after Myocardial Infarction (Developments in Cardiovascular Medicine) Editors: C.T. Kappagoda and P.V. Greenwood Martinus Nijhoff Publishing, Boston/ Dordrecht/ Lancaster, 1988; 244 pp.; Dfl. 125, $50, E34.50; ISBN O-89838-352-8 It is now well established that the prognosis after recovery from an index acute myocardial infarction is determined by many variables, but particularly age and the degree of left ventricular damage. There are many ways, some simple, others complex, of attributing likely risks to individual survivors, even those who appear resolutely symptom-free and whose “risk” is only exposed by exercise testing, Holter monitoring, or coronary angiography. As for post-infarct management the questions are endless - perhaps some are answered in this volume? After an introduction by Nanette Wenger, there follow four sections - patterns of coronary arterial disease and survival, assessment of function, therapeutic options, and future trends. Rather than confine itself to the survivors of infarction, however, there is also discussion on pre-hospital demography, in-hospital acute intervention (both medical and surgical), and of various ways in which risk stratification can be applied. Unfortunately there is precious little discussion of controlled data in which risk, once assessed, can be modified, except by use of beta-adrenoceptor blocking drugs. From the general, the text moves to the particular problems - when (not if) coronary angiography should