- Email: [email protected]
Guide to Prosthetic Cardiac Valves
335 How to Do It: Jones and David: Gelfoam Occlusion of Bronchopleural Fistulas
may be poorly tolerated i n an already compromised patient. If t h e air leak can b e stopped endobronchially, however, t h e pneumothorax should be eliminated by hyperinflation of the remaining l u n g and by mediastinal shift. Only a few reports of successful endobronchial control of bronchopleural fistulas have appeared i n t h e literature. Hartmann a n d Rausch [l] successfully sealed a right u p p e r lobe fistula with the tissue glue methyl-2cyanoacrylate (Histacryl). Ratliff a n d colleagues [2] used endobronchial lead shot to seal a fistula caused by high positive-pressure ventilation in a patient with adult respiratory distress syndrome. Unfortunately, as this patient died of the parenchymal l u n g disease, long-term follow-up w a s not available. Ellis a n d co-workers [3] attempted to control a fistula secondary to Staphylococcus aureus pneumonia a n d positive-pressure ventilation with a n endobronchial balloon catheter, b u t this technique can be considered temporary a t best. The balloon, however, has proved to be t h e ideal method of identifying the segmental bronchus leading to the fistula.
There a r e many theoretical advantages to t h e use of Gelfoam as an endobronchial blocker. It is readily available, easy to use, nontoxic, and completely phagocytosed within one month. Although atelectasis o r pneumonia can occur i n t h e obstructed segment, neither complication appeared in o u r patient. W e believe that this technique also could be used i n high-risk emphysematous patients with spontaneous pneumothorax and prolonged air leak a n d i n ventilated patients with barotrauma-induced pneumothorax, i n whom continuing air leak may cause marked gas exchange abnormalities.
References 1. Hartmann W, Rausch V: A new therapeutic application of the fiberoptic bronchoscope. Chest 71:237, 1977 2. Ratliff JL, Hill JD, Tucker H, Fallat R: Endobronchial control of bronchopleural fistulae. Chest 71:98, 1977 3. Ellis JH, Sequeira FW, Weber TR, et al: Balloon catheter oc-
clusion of bronchopleural fistulae. American Journal of Roentgenology 138:157, 1982
REVIEW OF RECENT BOOKS
Guide to Prosthetic Cardiac Valves Edited by Dryden Morse, Robert M . Steiner, and lavier Fernandez New York, Springer-Verlag, 1985 362 p p , illustrated, $89.50 Reviewed by Eric D. Foster, M.D.
This compendium lives up to its title as a guide to prosthetic heart valves without the stifling redundancy sometimes seen in a multiauthor text. The reader is directed through the highlights of the historical, developmental, and clinical aspects of prosthetic cardiac valves. In general, the discussions touch on all major points, but are not exhaustive. Each chapter concludes with a full set of references, usually well organized and selected. After an introduction on the historical perspective of prosthetic cardiac valves by field pioneer Viking Bjork, the guide returns the reader to the early-1980s perspective. The chapters on preoperative evaluation of patients for valve implantation and postoperative management are basic, but up-to-date. They are well suited for medical students and residents training in cardiology and cardiac surgery and as reviews for the more experienced clinician. Important chapters on the radiology and ultrasonography of artificial cardiac valves feature concise descriptions and excellent illustrations of these noninvasive techniques. Deserving equal praise is the chapter on prosthetic cardiac valves for children, which details unique features of the pediatric group and nicely complements a text with an otherwise adult angle.
The guide devotes extensive coverage to the surgical aspects of valve implantation over the past quarter-century. It is here, if anywhere, that the text suffers from redundancy, although the authors’ desire for completeness is appreciated. A student of prosthetic cardiac valves can find useful information in this section no matter what his or her level of experience or training. Often in medicine it is the pathologist who places the stateof-the-art in proper perspective, as in the chapter on pathology of cardiac valve replacement. Dramatically emphasized by fine photographs, this chapter chronicles the prosthetic valverelated complications of thrombosis, degeneration, infection, dehiscence, and mechanical destruction. Two unique features of this volume merit emphasis. First, the chapter on bioengineering of mechanical and biological heart valves, understandable even to the layperson, provides basic information on prosthetic valve in vitro analysis and function. Second, a prosthetic cardiac valve identification atlas pictures most, if not all, artificial valves ever manufactured and their roentgenographic appearance. The atlas also lists physical characteristics, dates of manufacture and discontinuance, size ranges and available dimensions, and in many instances, 1985 costs. The guide belongs in all training program libraries. It meets its goal of being “a useful and practical reference source for cardiologists, internists, radiologists, surgeons, emergency room physicians, and others who deal with patients suffering from valvular heart diseases.” Albany, N Y
may be poorly tolerated i n an already compromised patient. If t h e air leak can b e stopped endobronchially, however, t h e pneumothorax should be eliminated by hyperinflation of the remaining l u n g and by mediastinal shift. Only a few reports of successful endobronchial control of bronchopleural fistulas have appeared i n t h e literature. Hartmann a n d Rausch [l] successfully sealed a right u p p e r lobe fistula with the tissue glue methyl-2cyanoacrylate (Histacryl). Ratliff a n d colleagues [2] used endobronchial lead shot to seal a fistula caused by high positive-pressure ventilation in a patient with adult respiratory distress syndrome. Unfortunately, as this patient died of the parenchymal l u n g disease, long-term follow-up w a s not available. Ellis a n d co-workers [3] attempted to control a fistula secondary to Staphylococcus aureus pneumonia a n d positive-pressure ventilation with a n endobronchial balloon catheter, b u t this technique can be considered temporary a t best. The balloon, however, has proved to be t h e ideal method of identifying the segmental bronchus leading to the fistula.
There a r e many theoretical advantages to t h e use of Gelfoam as an endobronchial blocker. It is readily available, easy to use, nontoxic, and completely phagocytosed within one month. Although atelectasis o r pneumonia can occur i n t h e obstructed segment, neither complication appeared in o u r patient. W e believe that this technique also could be used i n high-risk emphysematous patients with spontaneous pneumothorax and prolonged air leak a n d i n ventilated patients with barotrauma-induced pneumothorax, i n whom continuing air leak may cause marked gas exchange abnormalities.
References 1. Hartmann W, Rausch V: A new therapeutic application of the fiberoptic bronchoscope. Chest 71:237, 1977 2. Ratliff JL, Hill JD, Tucker H, Fallat R: Endobronchial control of bronchopleural fistulae. Chest 71:98, 1977 3. Ellis JH, Sequeira FW, Weber TR, et al: Balloon catheter oc-
clusion of bronchopleural fistulae. American Journal of Roentgenology 138:157, 1982
REVIEW OF RECENT BOOKS
Guide to Prosthetic Cardiac Valves Edited by Dryden Morse, Robert M . Steiner, and lavier Fernandez New York, Springer-Verlag, 1985 362 p p , illustrated, $89.50 Reviewed by Eric D. Foster, M.D.
This compendium lives up to its title as a guide to prosthetic heart valves without the stifling redundancy sometimes seen in a multiauthor text. The reader is directed through the highlights of the historical, developmental, and clinical aspects of prosthetic cardiac valves. In general, the discussions touch on all major points, but are not exhaustive. Each chapter concludes with a full set of references, usually well organized and selected. After an introduction on the historical perspective of prosthetic cardiac valves by field pioneer Viking Bjork, the guide returns the reader to the early-1980s perspective. The chapters on preoperative evaluation of patients for valve implantation and postoperative management are basic, but up-to-date. They are well suited for medical students and residents training in cardiology and cardiac surgery and as reviews for the more experienced clinician. Important chapters on the radiology and ultrasonography of artificial cardiac valves feature concise descriptions and excellent illustrations of these noninvasive techniques. Deserving equal praise is the chapter on prosthetic cardiac valves for children, which details unique features of the pediatric group and nicely complements a text with an otherwise adult angle.
The guide devotes extensive coverage to the surgical aspects of valve implantation over the past quarter-century. It is here, if anywhere, that the text suffers from redundancy, although the authors’ desire for completeness is appreciated. A student of prosthetic cardiac valves can find useful information in this section no matter what his or her level of experience or training. Often in medicine it is the pathologist who places the stateof-the-art in proper perspective, as in the chapter on pathology of cardiac valve replacement. Dramatically emphasized by fine photographs, this chapter chronicles the prosthetic valverelated complications of thrombosis, degeneration, infection, dehiscence, and mechanical destruction. Two unique features of this volume merit emphasis. First, the chapter on bioengineering of mechanical and biological heart valves, understandable even to the layperson, provides basic information on prosthetic valve in vitro analysis and function. Second, a prosthetic cardiac valve identification atlas pictures most, if not all, artificial valves ever manufactured and their roentgenographic appearance. The atlas also lists physical characteristics, dates of manufacture and discontinuance, size ranges and available dimensions, and in many instances, 1985 costs. The guide belongs in all training program libraries. It meets its goal of being “a useful and practical reference source for cardiologists, internists, radiologists, surgeons, emergency room physicians, and others who deal with patients suffering from valvular heart diseases.” Albany, N Y