Introductory Guide to Cardiac Catheterization
Ronnier J. Aviles; Adrian W. Messerli; Arman T. Askari; Marc S. Penn; Eric J. Topol
176 pages. Philadelphia, Pa: Lippincott Williams & Wilkins; 2004. $45.00. ISBN 0-7817-5202-7
In an era where cardiovascular textbooks are becoming dauntingly voluminous to accommodate both classical and modern understanding in physiology and historical and contemporary data from clinical studies, Introductory Guide to Cardiac Catheterization provides a back-to-basics approach. The authors should be congratulated for effectively condensing a large body of information surrounding the fundamentals of cardiac catheterization and basic hemodynamic principles. As acknowledged in the preface, the text is written primarily by cardiology fellows “who remember well what it was like to enter the cath laboratory for the first time,” and it is this audience that stands to benefit most from this manual. A consistent reaction from some of our junior fellows included “just what we needed” when surveyed about this book.
The book is divided into 10 chapters covering everything from “pre-cath” to “post-cath,” and includes the basics of native coronary and bypass graft angiography, left ventriculography, aortography, and hemodynamics. An important section of this text addresses the management of patients after the procedure, including activity restrictions, which tend to be overlooked by cardiovascular trainees. Each concise and easy-to-read chapter is liberally filled with tables and figures that further summarize the main points contained therein. One of our favorite features was the shaded boxes on troubleshooting. These help provide a practical approach to problems frequently encountered, including anatomically difficult to engage coronary ostia, a dampened pressure waveform, or difficulty advancing a guidewire. Each chapter identifies key references that facilitate the further reading that is essential to all trainees. There are some limitations, which are inherent to any book of this size. It would be impossible to offer an exhaustive discussion surrounding calculation of a stenotic valve area, but this is not always necessary for the beginner in the catheterization laboratory. A few of the black-and-white angiograms and x-rays did not print as clearly in the book as one would like, but the explanatory text and hemodynamic illustrations make up for this shortcoming.
As the field of cardiovascular medicine expanded to include such specialized and disparate modalities as electrophysiology, heart failure, vascular medicine, and computed tomography/magnetic resonance imaging, training in cardiac catheterization became compressed into a few months of high clinical intensity. Given the invasive nature of cardiac catheterization and intervention, where errors in procedural technique are not easily forgiven, the pressure to absorb and relay clinical details on multiple patients can rapidly supersede a genuine interest in the field. In this challenging environment, it is perhaps not surprising that even the most earnest fellow can adopt short-cut solutions to complex situations (for example, accepting computer calculations of valve area without careful contemplation). In this context, we acknowledge the notion that there is indeed requirement for a new condensed style of book on cardiac catheterization. This Introductory Guide fits the bill perfectly and is well-planned, easy to read, and thoughtfully illustrated. For more seasoned physicians, this synopsis provides pleasurable reading, taking only a few hours to peruse in its entirety and reminding us of clinical highlights to emphasize in our teaching. For cardiologists in general clinical practice spending only a fraction of their time in the catheterization laboratory, this book will provide a “refresher” on the pearls of catheterization laboratory techniques. In summary, this book offers a welcome addition to the growing library of cardiology and cardiac catheterization.