Diagnostic and Therapeutic Cardiac Catheterization
Carl J. Pepine. 1066 pp, illustrated. Baltimore, Md: Williams & Wilkins; 1998. $99.00. ISBN 0–683-30125-X.
The rapid growth of information in the area of invasive and interventional cardiology has resulted in a plethora of texts focusing on interventional techniques and complications. Many of these texts reflect the experiences of the authors. Fortunately, a small amount of reading can prove to be educational. There are few texts that remain committed to educating the reader about the broad topic of invasive cardiology. This text, Diagnostic and Therapeutic Cardiac Catheterization, is most remarkable for having started with the basics and continued into the difficult arena of how to integrate both invasive and noninvasive data in managing the individual patient. In doing so, the editors have remained true to the original purpose of the first edition.
Administration of the catheterization laboratory is a problem infrequently addressed in most texts. For the novice or expert in the catheterization laboratory, the first 6 chapters provide an important overview of issues such as credentialing, staffing, and patient selection. An interesting entry is the chapter on avoiding conflict in the catheterization laboratory. These chapters will be welcomed by medical and technical directors for having succinctly addressed contemporary issues and provided important references for further investigation.
Section 3 is dedicated to basic concepts and techniques. The authors have not chosen to distinguish between diagnostic and interventional procedures. This reflects the current attitudes in the catheterization laboratory that the diagnostic patient often undergoes an interventional procedure immediately after the diagnostic procedure. The explanations of the procedural technique are not comprehensive but provide the reader with an appreciation of the intellectual aspects of invasive procedures.
Chapter 11, which provides an overview of radiographic equipment, is recommended to everyone involved in cardiac catheterization. The technical considerations of equipment needs are often overlooked today. The capital investment in this equipment is often several million dollars, which reinforces why a detailed understanding of each of the components of the imaging and data storage systems is critical for patient care. Given the importance of providing cost-effective patient care, thoughtful selection and compulsory maintenance of the equipment is mandatory for efficient care in this setting.
There is a lamentable lack of emphasis in many works on the hemodynamic assessment of patients in the catheterization laboratory. Visual assessment of anatomy is only 1 important component of the cardiac catheterization. The documentation and analysis of waveforms, pressure differences, and flow are also important in defining pathological conditions. Detailed chapters are dedicated to assessment of flow and stenoses. Given the increasing numbers of patients with valvular and congenital heart disease, the reader is referred to the discussions of determination of shunt severity as well as valvular regurgitation and stenosis.
An in-depth understanding of therapeutic interventional technique is important for every individual who treats cardiovascular disease. Whether you perform the procedure, participate in patient care, or evaluate outcomes, the chapters discussing interventions will be instructive.
In summary, this text, while designed as a general overview of the cardiac catheterization laboratory, provides a richly detailed work that holds information for everyone who practices in the cardiac catheterization laboratory. The price is moderate, and the return on investment is large. Dr Pepine and his colleagues have achieved the very difficult goal of providing an informative general text in a subspecialty environment.
- Copyright © 1999 by American Heart Association