Ziyad M. Hijazi, Philipp Bonhoeffer, Ted Feldman, Carlos E. Ruiz, eds
382 pages. London, UK: Taylor & Francis; 2006. $95.00. ISBN 1-84184-472-1
Modern interventional cardiology is grounded in the performance of percutaneous coronary interventions. However, beginning with the introduction of atrial septostomy and then followed by percutaneous balloon valvuloplasty, noncoronary interventions have provided a growing contribution to general procedures in the cardiac catheterization laboratory. Today, up to 30% of all interventions reflect a growing list of both peripheral procedures and cardiac noncoronary interventions for structural and valvular heart disease.
The first successful valvular interventions, namely balloon valvuloplasty for pulmonic, mitral, and aortic stenosis, were performed more than 20 years ago, but only recently have successful interventions for aortic stenosis and regurgitant valvular disease been developed and attempted. The combination of these valvular interventions, other interventions for patients with structural heart disease, and the growing population of adults with congenital heart disease provide the basis for a whole new subspecialty within interventional cardiology. This book is one of the first to specifically address this new subspecialty. It was compiled by a who’s who of pioneers in this new field. To be successful, this book must meet numerous challenges. First, it has to deal with a rapidly moving and developing field. Second, it must bridge the worlds of adult cardiology, pediatric cardiology, and adults with congenital heart disease. Next, it must deal with the pathophysiology of 4 very different valves and their associated lesions. Finally, it must cover a wide spectrum of knowledge for cardiologists, who diagnose these illnesses, have previously treated them with medications, and now must understand mechanical interventions, as well as cardiac surgeons, who typically see later stages of these diseases and treat them very differently. Despite these challenges, this book is admirably successful at achieving all of these goals.
The book is divided into 6 sections, the first 4 of which treat each of the valves separately. The fifth and sixth section comprise 1 chapter each on tissue engineering and valve testing. The first section addresses the pulmonary valve. Chapters deal with embryology, pathophysiology, and treatments, including pulmonary valve replacement. The hemodynamic evaluation reflecting the perspective of both pediatric and adult patients is nicely divided between 2 chapters. One criticism of this section is the lack of a specific chapter on balloon valvuloplasty in both children and adults, particularly as this was the first successful application of percutaneous treatment for a valve lesion.
The second section deals with the aortic valve and has particularly elegant chapters on echocardiographic and hemodynamic assessment. The impact of new percutaneous techniques for aortic valve replacement and the surgical results are described in 3 chapters. The results with percutaneous valve replacement for aortic stenosis are described in separate chapters dealing with the Edwards valve and the CoreValve, as well as a futuristic chapter on a nano-synthesized metallic valve. This section could benefit from a chapter on the embryology of aortic valve disease. In addition, the chapter on the history of nonsurgical aortic valve replacement could be expanded to include information on clinical trial design and patient selection for this new therapy.
The third section deals with the mitral valve and has 2 chapters on the embryology and etiology of mitral valve disease. There was some duplication between these 2 chapters, but they are both well written. Even though both chapters describe mitral stenosis, there is again no chapter or discussion in detail of percutaneous balloon valvuloplasty for rheumatic disease. The chapter on surgical therapy emphasizes repair techniques, with only sparse data on valve replacement and the outcomes. There is a good description of percutaneous edge-to-edge repair utilizing the clip technique, as well as a good chapter on percutaneous coronary sinus indirect annuloplasty. The suture-based edge-to-edge leaflet repair technique that is now in phase I clinical trials was not covered in this section and will need to be added to future additions.
Finally, the tricuspid valve is dealt with in section IV. There is an excellent chapter on cardiac magnetic resonance imaging, but no embryologic discussion. The hemodynamics, surgical treatment, and the development of one device for percutaneous replacement of the tricuspid valve comprise the remaining chapters.
Sections V and VI probably do not deserve separate sections at the present time, given that there is only 1 chapter in each. Nonetheless, the use of heart valve tissue engineering and the importance of valve testing represent important additions to the book. In this regard, the chapter on valve testing is interesting, but should be supplemented by more discussions of trial design and the Food and Drug Administration pathways to approval.
Overall, the book is an excellent compilation of a fast and newly developing field. There is liberal use of color illustrations. In the future, the use of videos or movies on an accompanying CD or DVD might be considered. Most of the chapters are relatively short and concise. Some of the information on basic pathophysiology and surgery is available elsewhere, although the inclusion of this information in this book allows a single reference for this and the clinical information on percutaneous techniques for valvular repair and replacement.
I think cardiologists, both pediatric and adult, and cardiac surgeons will find something of interest in this book. As this field develops and more clinical information becomes available, it is likely that future editions will include more outcomes data and will allow this first-rate book to develop into a classic.
Dr Herrmann received research funding from Evalve, Inc, and has equity in Endovalue, Inc.