Cardiac Catheterization in Congenital Heart Disease: Pediatric and Adult
Charles E. Mullins, MD
932 pages. Oxford, UK: Blackwell Publishing; 2006. £125 UK. $225.00 US. ISBN: 1-40512-200-5
The figures included in Cardiac Catheterization in Congenital Heart Disease reveal, in a simple yet powerful way, the basic strengths and characteristics of this long-awaited textbook from Charles Mullins. Line drawings demonstrating the intended course of needles, catheters, wires, and devices take the place of the fluoroscopic images and angiograms typically provided in catheterization textbooks. The idealization of these images is emblematic of the precision, deliberation, and attention to detail with which the author has approached catheterization of the child with congenital heart disease, an approach that has been successfully handed down to dozens of talented and dedicated trainees.
In further evidence of the personal perspective of this work, Dr Mullins notes in the introduction that the line drawings are provided by one of his own patients. In another field of medicine, or perhaps coming from another author, this highly personalized and often anecdotal approach might diminish the value of the text for its readers. However, this type of reference is familiar to those established in the field of diagnostic and interventional catheterization in congenital heart disease. In fact, Cardiac Catheterization in Congenital Heart Disease succeeds as a highly useful, instructive, and valuable textbook, largely as the result of Dr Mullins’s very personal view of his subject matter. In a field created and dominated by only a handful of leaders who have, in one fashion or another, trained almost all of the practitioners around the world, the publication of the experience that Dr Mullins gained over 40 years in the catheterization laboratory presents a milestone in pediatric interventional catheterization. This book codifies Dr. Mullins’s approach and provides, in a highly organized and readable format, a great deal of information relevant to pediatric interventional practice that has been, until now, passed through piecemeal reviews, book chapters, and much smaller, more focused textbooks.
The 35 chapters dedicated to this small, highly specialized field with unique technical demands covers topics ranging from the optimal floor plan of a modern pediatric interventional catheterization laboratory, to the energy requirements for radiofrequency perforation of an atretic valve, to the precise method of handling guide wire positioning in the distal part of the circulation during balloon dilation and stent implantation. Despite the remarkable breadth of the content, such a detailed categorical approach from a single author will necessarily result in repetition of some important concepts and technical details. This tendency to repetition is manifested in chapters throughout the book and may be intended by the author to emphasize specific principles or practices that he feels quite strongly about. Indeed, the liberal use of italics for emphasis makes abundantly clear the strength with which some opinions are held.
Pediatric cardiologists who do not perform interventional catheterization are unlikely to find this book to be an easily accessible reference. The intent is clearly to provide a comprehensive, detailed technical manual. Pages full of highly specific and useful technical information are unlikely to hold the attention of anyone who cannot actually picture himself or herself doing the procedure described. The chapter on transcatheter atrial septal defect occlusion arms the interventional cardiologist with detailed knowledge of all the available occluding devices and the particular tricks for using each of these devices and delivery systems in a full 50 pages of text. Similar attention is paid to techniques and tools for obtaining vascular access and for performing balloon dilations. Although some of the very specific information provided will become obsolete rather quickly, points on the prioritization of balloon characteristics desirable for a particular intervention, or the general principles of wire placement and device handling will always remain relevant.
As a technical manual, this text is extremely successful. Missing, however, from essentially all of the chapters are quantitative discussions regarding the results of procedures, the indications for procedures, the frequency of complications, and other forms of outcome data for these inherently invasive diagnostic and therapeutic techniques. Similarly, the author’s views on important issues in the field, stated with clarity and precision, are often unsupported by references to prior work or specific experience that might allow a reader a better understanding of the factual basis for views and recommendations. In an era of outcomes research and measuring one’s results against those of other operators and centers, the absence of outcomes data and lack of quantitative assessment of results, complications, and adverse events will limit the utility of this textbook for certain purposes.
Nonetheless, this textbook will accomplish the author’s goal of providing useful information to readers practicing at any level within the subspecialty field of pediatric interventional cardiology. To trainees and those recently entering the practice who may have had extensive exposure to pediatric interventional techniques but limited hands-on experience, this text will serve to solidify many of the concepts and common techniques used in the pediatric interventional laboratory. Advanced operators will use it as a reference and a technical narrative of minute details to aid in the planning of particular cases or in the management of infrequently encountered situations. As such, it is an enormously useful and long-awaited addition to the field of pediatric cardiology.