Congenital Heart Disease in Adults
Joseph K. Perloff, MD and John S. Child, MD. 406 pp. Philadelphia, Pa: WB Saunders; 1997. $110.00. ISBN 0-7216-2998-9.
“… it is the past that is in front of us; it is the future that lies behind us.” —James Downy
The diagnosis and treatment of congenital heart disease is one of the greatest medical success stories witnessed in the latter half of the 20th century. An estimated 32 000 infants with newly diagnosed congenital cardiovascular lesions are born in the United States each year. First-year mortality rates have dropped 50% since the l960s. Currently, ≈80% of first-year survivors live to reach adulthood. By the year 2000, the estimated prevalence of adults with congenital heart disease in the United States alone is expected to approach 1 million.1
The result of converging advances in medicine, pediatrics, and cardiovascular surgery, this achievement highlights the impact of a well-crafted multidisciplinary collaborative effort. In that spirit, Perloff and Child have published the second edition of Congenital Heart Disease in Adults. Considerably expanded from the first edition, coverage spans pertinent topics from medical history to diagnostic technology and surgical technique, incorporating a description of facilities needed to render complete patient care. Although its scope is wide, the book is focused, cohesive, and superbly written. UCLA Medical Center, known for its pioneering work in the field of congenital heart disease, both pediatric and adult, has made landmark contributions to the international medical community since the inception of its Adult Congenital Heart Disease Center in l978. Justifiably, the center serves as a single site where multiple subspecialists contribute long-standing experience to produce a highly comprehensive textbook, tightly edited and largely coauthored by Perloff and Child.
The book contains 20 chapters divided into 5 sections. The first chapter provides an elegant documentation of historical and current perspectives on congenital heart disease in general and adult congenital heart disease in specific. The second chapter details the organization of recommended specialized facilities best suited to deliver clinical service, training, and research in a tertiary care setting. The second section, entitled “Survival Patterns,” is divided into 2 chapters describing the narrowing base of patients who have not had surgery and the expanding population of patients after intervention. Information on each lesion is given in both chapters. This section serves as a basis for the conceptual approach to the adult with congenital heart disease and underscores the impact of surgery on survival. The third section encompasses 8 chapters on medical considerations, the first of which outlines the use of transthoracic and transesophageal echocardiography. The chapter on cardiac ultrasound written by Child contains extensive information, both technical and medical, in addition to well-appointed illustrations. Both reflect the author’s experience in the field. The remaining 7 chapters of this section provide detailed coverage of issues related to infective endocarditis; pregnancy; genetic transmission; recommendations for exercise; systemic complications of cyanosis; psychiatric and psychosocial issues; and neurological disorders. In the fourth section, 4 chapters outline both general and specific surgical considerations for each lesion. Surgical technique and materials, diagnostic and interventional cardiac catheterization, and issues related to noncardiac surgery are detailed. In the fifth section, 4 chapters describe electrophysiological, hemodynamic, and myocardial residua and sequelae after surgical and nonsurgical intervention. Throughout the chapters in the fourth and fifth sections, long-term complications related to specific lesions are outlined. The last chapter on myocardial growth and ventricular mass is an original and informative analysis of myocardial response from the fetus to the adult in health and disease and after therapy.
The organization of the book highlights the multisystem, problem-oriented approach to healthcare delivery in this group of patients. Complete and careful indexing allows identification of issues pertinent to specific anatomic lesions, whether treated by surgery or not. The book is amply illustrated. A unique collection of high-quality prints exemplifies specific physical findings, pathological and histological specimens, x-rays, and angiographic and echocardiographic views in addition to ECGs, surgical drawings, and historical photographs.
Learning from this book is a pleasurable experience for the student of adult congenital heart disease at any level. The wealth of information ranges from the basic to the complex. The end product is luxuriously assembled as can only be done when knowledge meets experience. Perloff and Child have provided us with a classic textbook.
- Copyright © 1998 by American Heart Association