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International Trends in Thoracic Surgery. Volume 2. Major Challenges
436 The Annals of Thoracic Surgery Vol 43 No 4 April 1987
agement alone or combined with intraaortic balloon pump [l],biventricular assist device [2], or right ventricular assistance with balloon counterpulsation [3-51 or mechanical pump [6] have been used in these situations with various degrees of success. In the presence of adequate left ventricular function, isolated right ventricular failure may occur in a number In of situations, as outlined by Moran and colleagues [4]. these settings assistance of the failing right ventricle alone would be appropriate and should be started without delay. The method of assistance chosen will depend on the conditions available in each service. We created an ASD in our patient because both of our unit’s balloon pumps were in use at that time and current ventricular assist devices were not available. Opening the right atrium and excising a small segment of the fossa ovalis took only a few minutes. On reviewing the literature, we found a report by Parr and co-workers (71, in which they attributed the successful outcome in a patient with acute postperfusion right ventricular failure to the presence of a patent foramen ovale that acted as an ASD, decompressing the right ventricle. We believe that the creation of an ASD in patients similar to the one described herein should be kept
in mind, especially if more aggressive measures are unavailable.
References 1. Bemhard WF, Berger RL, Stetz JP, et al: Temporary left ventricular bypass: factors affecting patient survival. Circulation 6O:Suppl 12:131, 1979 2. Turina M, Bosio R, Senning A: Clinical application of paracorporeal and biventricular artificial heart. Trans Am SOCArtif Intern Organs 24:625, 1978 3. Miller DC, Moreno Cabral RJ, Stinson EB, et al: Pulmonary artery balloon counterpulsation for acute right ventricular failure. J Thorac Cardiovasc Surg 80:760, 1980 4. Moran JM, Opravil M, Gorman EJ, et al: Pulmonary artery balloon counterpulsation for right ventricular failure: 11. Clinical experience. Ann Thorac Surg 38:254, 1984 5. Flege JB, Wright CB, Reisinger TJ: Successful balloon counterpulsation for right ventricular failure. Ann Thorac Surg 37167, 1984 6. ONeill MJ, Pierce WS, Wisman CB, et al: Successful management of right ventricular failure with the ventricular assist pump following aortic valve replacement and coronary bypass grafting. J Thorac Cardiovasc Surg 87:106, 1984 7. Parr GVS, Pierce WS, Rosenberg G, et al: Right ventricular failure after repair of left ventricular aneurysm. J Thorac Cardiovasc Surg 80:79, 1980
REVIEW OF RECENT BOOKS
International Trends in Thoracic Surgery. Volume 2. Major Challenges Edited by Hermes C . Grillo, M . D . , and Henry Eschapasse, M . D . Philadelphia, Saunders, 1986 528 p p , illustrated, $55.00
Reviewed by Melvin M . Newman, M . D . In the introduction the editors discuss general thoracic surgery as a discipline distinct from cardiovascular surgery. As in any changing field, regional opinions and approaches evolve and differ. This encyclopedia by 97 authors has six sections on tracheal problems (148pages), respiratory intensive care (72 pages), the injured chest wall, covering blunt trauma to the chest wall and its contents, and surgery of chest wall tumors (108 pages), thoracic outlet syndrome (37 pages), major complications (90 pages), and infantile and childhood lobar emphysema (17 pages). In the first third of the book are deeply probing discussions about tracheal disease and reconstruction, which reflect the major contributions of Grillo, Pearson, and Perelman over the past two decades. Most sections contain good historical introduc-
tions and extensive bibliographies with references to areas of the medical literature seldom explored by thoracic surgeons. Areas that especially appealed to me are utility and limitations of laser surgery for tracheal lesions, postoperative analgesia and intensive care, and high frequency pulmonary ventilation. Concise discussions that follow many chapters often are more illuminating than the preceding discursive essays. The editors, having interfered little with organization and style, allowed considerable redundancy and sometimes idiomatically strained (yet grammatically correct) sentences to ensure a diversity of viewpoints. Line drawings are fine but reproductions of photographs and roentgenograms are in general disappointing. House officers in thoracic surgery, anesthesiology, and otolaryngology will find this a useful book that provides historical framework for current practices and suggests questions for the future. The experienced thoracic surgeon may gain a sense from this book of what a generally competent surgeon can accomplish and what problems are best referred to centers of highly focused expertise. As Courand and Hafez emphasize (page 57), “Surgical failure in difficult situations all too often aggravated initial lesions.”
Pasadena, CA
agement alone or combined with intraaortic balloon pump [l],biventricular assist device [2], or right ventricular assistance with balloon counterpulsation [3-51 or mechanical pump [6] have been used in these situations with various degrees of success. In the presence of adequate left ventricular function, isolated right ventricular failure may occur in a number In of situations, as outlined by Moran and colleagues [4]. these settings assistance of the failing right ventricle alone would be appropriate and should be started without delay. The method of assistance chosen will depend on the conditions available in each service. We created an ASD in our patient because both of our unit’s balloon pumps were in use at that time and current ventricular assist devices were not available. Opening the right atrium and excising a small segment of the fossa ovalis took only a few minutes. On reviewing the literature, we found a report by Parr and co-workers (71, in which they attributed the successful outcome in a patient with acute postperfusion right ventricular failure to the presence of a patent foramen ovale that acted as an ASD, decompressing the right ventricle. We believe that the creation of an ASD in patients similar to the one described herein should be kept
in mind, especially if more aggressive measures are unavailable.
References 1. Bemhard WF, Berger RL, Stetz JP, et al: Temporary left ventricular bypass: factors affecting patient survival. Circulation 6O:Suppl 12:131, 1979 2. Turina M, Bosio R, Senning A: Clinical application of paracorporeal and biventricular artificial heart. Trans Am SOCArtif Intern Organs 24:625, 1978 3. Miller DC, Moreno Cabral RJ, Stinson EB, et al: Pulmonary artery balloon counterpulsation for acute right ventricular failure. J Thorac Cardiovasc Surg 80:760, 1980 4. Moran JM, Opravil M, Gorman EJ, et al: Pulmonary artery balloon counterpulsation for right ventricular failure: 11. Clinical experience. Ann Thorac Surg 38:254, 1984 5. Flege JB, Wright CB, Reisinger TJ: Successful balloon counterpulsation for right ventricular failure. Ann Thorac Surg 37167, 1984 6. ONeill MJ, Pierce WS, Wisman CB, et al: Successful management of right ventricular failure with the ventricular assist pump following aortic valve replacement and coronary bypass grafting. J Thorac Cardiovasc Surg 87:106, 1984 7. Parr GVS, Pierce WS, Rosenberg G, et al: Right ventricular failure after repair of left ventricular aneurysm. J Thorac Cardiovasc Surg 80:79, 1980
REVIEW OF RECENT BOOKS
International Trends in Thoracic Surgery. Volume 2. Major Challenges Edited by Hermes C . Grillo, M . D . , and Henry Eschapasse, M . D . Philadelphia, Saunders, 1986 528 p p , illustrated, $55.00
Reviewed by Melvin M . Newman, M . D . In the introduction the editors discuss general thoracic surgery as a discipline distinct from cardiovascular surgery. As in any changing field, regional opinions and approaches evolve and differ. This encyclopedia by 97 authors has six sections on tracheal problems (148pages), respiratory intensive care (72 pages), the injured chest wall, covering blunt trauma to the chest wall and its contents, and surgery of chest wall tumors (108 pages), thoracic outlet syndrome (37 pages), major complications (90 pages), and infantile and childhood lobar emphysema (17 pages). In the first third of the book are deeply probing discussions about tracheal disease and reconstruction, which reflect the major contributions of Grillo, Pearson, and Perelman over the past two decades. Most sections contain good historical introduc-
tions and extensive bibliographies with references to areas of the medical literature seldom explored by thoracic surgeons. Areas that especially appealed to me are utility and limitations of laser surgery for tracheal lesions, postoperative analgesia and intensive care, and high frequency pulmonary ventilation. Concise discussions that follow many chapters often are more illuminating than the preceding discursive essays. The editors, having interfered little with organization and style, allowed considerable redundancy and sometimes idiomatically strained (yet grammatically correct) sentences to ensure a diversity of viewpoints. Line drawings are fine but reproductions of photographs and roentgenograms are in general disappointing. House officers in thoracic surgery, anesthesiology, and otolaryngology will find this a useful book that provides historical framework for current practices and suggests questions for the future. The experienced thoracic surgeon may gain a sense from this book of what a generally competent surgeon can accomplish and what problems are best referred to centers of highly focused expertise. As Courand and Hafez emphasize (page 57), “Surgical failure in difficult situations all too often aggravated initial lesions.”
Pasadena, CA