Oxford University Press, New York ( 1992). 215 pages, illustrated, $55.00 .... Futura Publishing Company, Inc., Mount Kisco, NY (1992). 458 pages, illustrated ...
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peas. The volume is a source for members of the theoretical medical disciplines as well as for intemists specializing in pulmonology and cardiology, and for surgeons in the cardiothoracic field.
H.G. Kroneberg wuppertal, Germany
Hypoxia, Metabolic Add& and the Circulation
Edited by Allen I. Arieff Oxford University Press, New York (1992) 215 pages, illustrated, $55.00 ISBN. 0-19-506062-8 In recent years the p b l e m s and consequences of hypoxia have been commented upon by many authors. It is now clear that the lungs and blood vessels as well as the heart and the circulation all play a role in the body’s response to hypoxia and its pathological consequences. This book, edited by A.I. Arieff, is part of the Clinical Physiology Series now consisting of 14 volumes. In 10 contributions from well known authors, the general pathogenesis of hypoxic metabolic acidosis is described in detail from several Merent perspectives-ellular to whole organ. In “Circulatory Regulation during Hypoxia and Hyperkapnia’V.K. Somers and EM. Abboud review the field, in particular the selectivity of the local effects of hypoxia and its role in modifying reflex vasoconstrictor responses. The interaction with central and peripheral chemoreceptors and the pulmonary and bmmeptor afYerents are discussed, as are the profound sympatheticactivation and the pathogenic relationship of sleep apneato mrial hype&nsion and its complications. J.I.E. Hoffman summarizes the “Regulation of Myocardial Blood Flow and Oxygen Delivery during Hypoxia” and concludes that the reduction of myocardial oxygen supply is compensated initially by coronary vasodilation, so that the product of flow and arterial oxygen content remains fairly normal. Described from a pathophysiological approach are several important clinical entities, which include current concepts of the pathogenesis of high altitude hypoxia, (J.B. West, San Diego), hypoxic lactic acidosis, idiopathic lactic acidosis, and cardiac m s t . A comprehensive contribution on effects of ischemia, hypoxia and cardiac systolic and diastolic function, and glycolytic metabolism in n o d and hypertmphied hearts relative to controls is given by C.S. Apstein (Boston),who concludes that one may suggest that an important link exists between a relative deficiency of hypoxic glycolytic metabolism and a p t e r degree of mechanical dysfunction in hypertmphid hearts relative to controls. The 123 r e f m n m are a key for special information. In the chapter “Clinical Manifestation of Hypoxia,” clinical implicationsof the pathophysiology of lactic acidosis, in particular the role of defects in lactate disposal are described by R.D. Cohen (London). B.E. and C. Marshall (Philadelphia) report on the influence of acidosis on the pulmomy circulation. The entire scope of problems with the therapeuticuse of sodium bicarbonate is presented by R.M. Bersin (Charlotte, North Carolina), M.H. Weil (Chicago)et al.;in particular the effects of bicarbonate and other alkalinizing agents are described from multiple metabolic viewpoints. Altematives to sodium bicahnate are discussed by A.I. Arieff (San Francisco). This volume, which grew out of a symposium sponsod by the American Physiological Society in 1988, gives a valuable review and the present state of the art. The articles contain the authors’ own experimental results as well as critical discussions and opinions. A comprehensive bibliography with many references at the end of every article may give rise to expanding studies of the ex-
Atrial Fibrillation: Mechanisms and Management
Edited by Rodney H. Falk and Philip J. Podrid Raven Press, New York (1992) 448 pages, illustrated, $95.00 ISBN: 0-88167-831-7 During the emergence of understanding of the mechanismsof human tachycardias the emphasis has been overwhelmingly on junctional and ventricular tachycardias, with atrial fibrillation somewhat sidelined. In the next decade, however, we will see greater attention given to atrial fibrillation.Already, there are major drug trials and epidemiological studies in progress (low-dose amiodarone study, CRAFT I and II treatment trials and various anticoagulanttrials) which will be reporting in the near future. This multiauthored text is a welcome contribution to the sparse textbook literature dealing exclusively with atrial fibrillation. Furthermore, it is not a disappointing, erratically edited byproduct of some symposium. On the contrary, it is consistently edited and the content matter thoughtfully selected. Almost every aspect of the subject is reviewed by 32 contributors in 22 chapters covering pathology, epidemiology, autonomic influences, pharmacologic and non-drug therapies, and many more aspects of atrial fibrillation. It is, in fact, difficult to find an area which is not properly discussed. Each contribution is well illustrated and extensively referenced. One notable omission from the index is “lone” atrial fibrillation but perhaps this reflects transatlantic differencesin usage. Even then, there is no entry under “idiopathic.” Without doubt, this is the most important text on the subject to be published to date and all those interested in the “cinderella” of cardiac arrhythmias will find this an invaluable some. David E. Ward London, England
Mcuspid Atresia, Second Edition
Edited by P.Syamasundar Rao Futura Publishing Company, Inc., Mount Kisco, NY (1992) 458 pages, illustrated, $98.00 ISBN: 0-87993-5 18-9 Somewhat unusually for me, and I suspect for most reviewers, I read this comprehensivetext on tricupsid atresia from cover to cover. It includes reference to virtually everything that has ever been written about tricuspid atresia. It will, therefore, be a textbook which many involved in the treatment of children and adults with congenital heart disease will wish to consult. I was disappointed with the classification of tricuspid atresia described,which I felt was outdated in part, and had some fundamental misconceptions. Also, the section on noninvasiveevaluation is particularly weak in its description of echocardiographic
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Book Reviews findings. It is surprising that for such a large textbook, so little space was devoted to transthoracic echocardiography and none to transoesophageal echocardiographyand Doppler. Finally, my overall impression is that the editor’s understanding of the lesion of tricuspid atresia is out of keeping with mainscream opinion in the current era. As far as I am concerned by far the most common type of right atrioventricular valvar atresia is absence of the right atrioventricular connection when only the left atrium connects directly with the ventricular mass, the right ventricle being small and rudimentary. Occasionally,the left atrium will connect to a dominant morphologically right ventricle or indeterminate ventricle although these are not, in morphological terms, true examples of tricuspid atresia. The clinical picture of tricuspid atresia is also found when there is an imperforaterightsided atrioventricularvalve, but this arrangement is uncommon. Although most cases of tricuspid atresia occur when the atria are arranged in normal fashion, similar clinical pictures can be encountered with situs inversus or with left or right atrial isomerism. Nevertheless, the book is so comprehensive that it will be a valuable publication for libraries or for one’s own bookself.
Michael L. Rigby London, England
Ultrafast Computed Tomography in Cardiac Imaging: Prindples and Practice
Edited by W i l l i a m Stanfod and John A. Rumbeqjer F u m Publishing Company, Inc., Mount Kisco, NY (1992) 35 1 pages, illustrated,$80.00 ISBN 0-87993-504-9 This is a useful book because it is the first to focus on the cardiac applications of the ultrafast CT scanner. The editors are highly experiencedin ultrafast CT scanning and have authored 13 of the 19 chapters. Information is provided about the various acquisition modes, specific protocols, and applications for specific imaging purposes. The first five chapters are detailed and precise, with respect to scanner characteristics, scanning modes, practical aspects of contrast administration,principles and practice of cardiac edge detection, normal cardiac anatomy, and evaluation of cardiacstructure and function. The next 12 chapters focus on specific imaging applications, including left and right ventricular function analysis at rest and with exercise, assessment of graft patency and flow, detection of coronary calcification, assessment of diastole, prospects for quantitating myocardial perfusion, intracardiac masses, valvular heart disease, pericardial disease, congenital heart disease, and aortic aneurysms and dissections. The diagrams in this book are superb, so that the reader has a clear visual impression of the data provided by this imaging device. The background technical and applied information is detailed and thorough. The references are comprehensive and include all of the important publications relative to ultrafast CT scanning of the heart. Largely because of the superb figures and the reference list, this book will be valuable for cardiologists and radiologists who have an occasion to examine CT scans of the heart. The weakest feature of the book is that it fails to bridge the gap between scientific documentation of physiologic accuracy and clinicalrelevance. For example, despite very high accuracies
for detection of bypass graft patency, no data are presented (or apparently exist) to demonstrate clinical relevance. The authors of this chapter express no opinion as to how to utilize the technology clinically for assessing bypass grafts.It was disappointing to learn that the evaluation of graft patency during the first several weeks after coronary bypass (a time when this question may frequently arise relative to acute electrocardiographic changes or atypical chest pains) is often inaccurate because of “mediastinalhematoma.” Lack of any significant discussion about coronary definition (aside from calcification) was also disappointing. There is widespread speculation that minimally invasive or noninvasive imaging techniques may be able to delineate prognostically important coronary anatomy, and some commentary on the future prospects of ultrafast CT for this purpose (versus magnetic resonance angiography, for example) would be useful. Finally, the editors are among the most experienced in the world employing ultrafast CT for clinical cardiac purposes. It is disappointing that there was no chapter dealing with their frank overview of the day-in and day-out clinical usefulness of this technology for the care of cardiac patients. The final chapters on limitations of ultrafast CT and its future are too brief and superficial to be meaningful. A chapter that specifically compares and contrasts the potential clinical utility of ultrafast CT for clinical decisionmaking versus echocardiography,radionuclide techniques, magnetic resonance imaging, and PET scanning would be valuable. Criticisms of lesser importance include a large amount of redundancy (for example, the table on page 22 appears three times in the book) and several instances where chapters seem either to have been written hurriedly or incompletely proofed (example, the last two paragraphs in Chapter 7). Overall, this book willbe a valuable I.eferencework for cardiology and radiology departments. Those searching for revelation from the experts as to the present role or future potential for ultrafast CT in routine clinical cardiac diagnostic work will be rllsappointed. Timothy M. Bateman
Kansas City, Missouri
BOOKS RECEIVED This listing acknowledges with appreciation the receipt of books sent to Clinical Cardiology.Books will be listed upon receipt in order to provide timelypublishing information.Books of particular interest will be reviewed in clinicalCardiology as spacepem‘ts.
Cardiology, 6ed.By Desmond G. Julian and J. Campbell Cowan. 416 pp., illustrated.Philadelphia,PA, W. B. Saunders, 1992.$32.50 Cardiovascular Disorders; Pathogenesis and Pathophyslology. By Michael B. Gravanis. 576 pp., illustrated. St. Louis, MO, Mosby-Year Book Inc., 1993. $95.00 Hernodynamic Rounds; Interpretation of Cardiac Pathophysiology From Presswe Waveform Analysis. By Morton J. Kern. 218 pp.. illustrated.New York, NY,John Wiley & Sons,Inc., 1993. $34.95 Human Cardiovascular Control By Loring B. Rowel. 499 pp., illustrated. New York, NY,Oxford University Ress, 1993.$65.00 Intmduction to Electrocardiography. By Paul L. Huang. 200 pp.. illustrated.Philadelphia, PA, W. B. Saunders, 1993. $17.95 Plasma Llpoproteh in Coronary Artery Msease. Edited by Robert A. Kreisberg and Jere P. Segrest. 390 pp.. illustrated. Cambridge, MA, Blackwell ScientificPublications,Inc., 1992. $74.95 Recent Advaaces in Cardiology. Edited by Derek J. Rowlands. New York, NY,Churchill Livingstone, 1992.318pp., illustrated.$79.95 SilentMyocsrdiel Ischemiaand I d a d o n , 3rd ed.By Peter F. Cohn. 288 pp., illustrated.New York,NY,Marcel Dekker, Inc., 1993. $79.75
