Pulmonary Circulation: Diseases and Their Treatment
Andrew J. Peacock, MPhil, MD, FRCP; Lewis J. Rubin, MD, eds
614 pp. London, UK: Arnold; 2004. $198.50. ISBN 0-340-80782-2
The complexity of the pulmonary circulation and the development of pulmonary hypertension have become very fashionable topics in the last few years. Several reviews on the diagnosis and treatment of pulmonary hypertension and the mechanism(s) of its development have appeared in major journals recently. However, these reviews have been limited to either treatment of pulmonary hypertension or description of current knowledge and theories on its development. As such, none of these reviews was intended or was able to encompass such an extensive topic as the pulmonary circulation completely. In fact, new information and understanding of the physiology and pathophysiology of the pulmonary circulation generated in the past decade would have precluded such a comprehensive review. That is why this book is an important and extremely practical overview of the subject.
Drs Peacock and Rubin have edited a clearly written, well-organized, and comprehensive overview of the pulmonary circulation. This text, an editorial collaboration between 2 well-known and well-respected pulmonologists, will be a useful compendium and reference source for pulmonologists and cardiologists, as well as any other individual whose research or clinical interests involve the normal or abnormal pulmonary vasculature.
The book is divided into 9 parts, summarizing all aspects of the pulmonary circulation. Beginning with an overview of the pulmonary circulation, Part 1 covers the structure and function of the normal pulmonary circulation in 2 chapters; these chapters cover the pulmonary vasculature and its microcirculation. Part 2 then discusses current knowledge of the pathophysiology and pathology of pulmonary vascular disease in 4 chapters, including the pathology of pulmonary vascular disease, hypoxic pulmonary vasoconstriction, pulmonary vascular remodeling, and the current status of the genetics of pulmonary hypertension.
Part 3 covers the diagnosis of pulmonary hypertension in 5 chapters that include clinical features, the role of echocardiography, other imaging techniques, cardiac catheterization, and an integral approach to the diagnosis of pulmonary hypertension. Part 4 is the largest section of the book and outlines disorders that are associated with pulmonary hypertension, detailing the first 3 groups of the recent World Health Organization (WHO) classification of pulmonary hypertension. This recent WHO classification is discussed in 1 chapter, followed by the most extensive chapter (Chapter 13), which includes multiple subchapters, detailing group 1 of the WHO classification: pulmonary arterial hypertension (PAH). The multiple subchapters encompass idiopathic and familial PAH, various disease processes associated with PAH, conventional therapies, recently approved and novel medical therapies, lung transplantation, atrial septostomy, and finally, a subchapter that outlines an integrated approach to the treatment of PAH. After this extensive discussion of PAH, there are discussions of pulmonary venous hypertension and pulmonary hypertension associated with respiratory disease and/or hypoxemia. The sections discussing pulmonary venous hypertension include subchapters that cover left heart disease (group 2 of the WHO classification) and pulmonary veno-occlusive disease and pulmonary capillary hemangiomatosis (both of which are still included in group 1 of the WHO classification). The subchapters that discuss pulmonary hypertension associated with respiratory diseases and/or hypoxemia (group 3 of the WHO classification) include subchapters on chronic hypoxic lung disease, obstructive sleep apnea, and an approach to the treatment of patients with hypoxic lung disease.
Part 5 describes pulmonary thromboembolic disease and pulmonary vascular tumors. In this part of the book, there are sections on the diagnosis and treatment of acute pulmonary thromboembolic disease, on chronic thromboembolic pulmonary hypertension (group 4 of the WHO classification), and on pulmonary vascular tumors.
Part 6 describes pulmonary hypertension in children and outlines the 2 major forms of pulmonary hypertension that occur in the pediatric population: persistent pulmonary hypertension of the newborn and primary pulmonary hypertension. Part 7 describes the pulmonary circulation in critical care situations, including the effects of mechanical ventilation on the pulmonary circulation, the effects of lung injury on the pulmonary circulation, and the pharmacological management of the pulmonary circulation in critically ill patients. Part 8 describes the pulmonary circulation in special or unique situations, including the pulmonary circulation during exposure to high altitude or during high-altitude pulmonary edema, the pulmonary circulation in the underwater environment (diving), and the pulmonary circulation in the fetus. Part 9 describes intrapulmonary shunts that occur within the pulmonary circulation, including the hepatopulmonary syndrome and pulmonary arteriovenous malformations.
In sum, this book provides a complete description of the pulmonary circulation and the pathological entities that ensue when this circulation does not function normally. It discusses almost every aspect of the pulmonary circulation and does so with excellent and very readable chapters. Overall, it is one of the best reference books produced on this subject; Drs Peacock and Rubin and the authors are to be commended for producing this exceptional review of a very difficult and poorly understood subject.
Dr Farber serves on the Speakers Bureau of Actelion, has received honoraria from Actelion, and is a consultant and advisory board member for MedaCorp and Gerson Lehrman.