(Circulation. 2001;103:e72.)
© 2001 American Heart Association, Inc.
Book Reviews |
Coronary Artery Anomalies: A Comprehensive Approach
Coronary Artery Anomalies: A Comprehensive Approach
Paolo Angelini, MD, Virginia D. Fairchild, MD, eds.
200 pp. Baltimore, Md: Lippincott Williams & Wilkins; 1999. $159.00. ISBN 0-7817-1018-9.
As William C. Roberts aptly states in his Foreword, Drs Angelini and Fairchild have done a splendid job, producing a book that will be a valuable resource for adult and pediatric cardiologists and cardiovascular surgeons. Chapters 1 and 2 (Phylogeny and Ontogeny of the Coronary Arteries) are scholarly accounts of developmental biology that are nicely illustrated. Chapter 3 deals with coronary anomalies and bicuspid aortic valve in the Syrian hamster. Although the information is interesting, even enlightening, it is unclear why this topic was given the prominence of a free-standing chapter rather than being incorporated into Chapter 1, in which hamster hearts and their coronary arteries were commented on.
Dr Angelini states in his Preface that Chapter 4 embodies the primary objectives of the book. Beginning with an informative historical background, the authors concern themselves with the definition of coronary normality, but they are then set adrift in a sea of words: normal, unusual but normal, atypical, abnormal, aberrant, anomalous, accessory, ectopic, incidental, a variant, a less common variant, and so on. The authors conclude that "abnormal or anomalous should be used for any form observed in <1% of the general human population," a recommendation that leaves the reader with a puzzled sense of unfulfilled expectations.
Chapter 4, together with its allied Case Report section, comprises two thirds of the book and includes a wealth of useful information. However, organizational balance would have been better served by dividing the lengthy chapter into several chapters, such as Historical Background and Coronary Anatomy, Incidence of Coronary Anomalies: Angiographic Analysis of 1950 Cases, Pathophysiologic Mechanisms, and Clinical Implications of Coronary Anomalies. The impressive 534 references with the Case Reports could then have been more usefully assigned to shorter, self-contained chapters.
Chapter 5, Coronary Anomalies in Pediatric Patients, and Chapter 6, The Relationship Between the Coronary Arteries and Congenital Heart Disease, carry titles that seem to overlap, prompting certain expectations of content. Chapter 5 deals with 2 major congenital coronary anomalies unassociated with coexisting congenital heart disease. Chapter 6 deals with coronary anomalies related to specific types of congenital heart disease. More appropriate titles would have put these 2 chapters into clearer context.
In a book commendable for comprehensive coverage of coronary artery anomalies, there are some noteworthy omissions. On page 55, the section on Coronary Ectasia or Aneurysm does not mention the dilated, serpiginous coronary arteries that characterize cyanotic congenital heart disease in adults, an abnormality that has been known for decades and is part of textbook literature. Further, in dealing with anomalous origin of the left coronary artery from the pulmonary trunk (page 48, Case Report 4.11 and pages 52 to 53), no mention is made of the regional increase in left ventricular mass due to replication (hyperplasia) of immature cardiomyocytes in response to hypoxemia.
The authors stated interest was coronary artery anomalies. It is nevertheless somewhat surprising that they did not mention, even in passing, the coronary venous circulation, for example, congenital abnormalities of the coronary sinus.
Coronary Artery Anomalies is uneven but, at its best, it is a valuable resource that I shall return to for specific information that is difficult to find elsewhere.
Joseph K. Perloff, MD
Ahmanson/UCLA Adult Congenital Heart Disease Center
Los Angeles, California.
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