(Circulation. 1998;98:1039-1040.)
© 1998 American Heart Association, Inc.
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.
Ariane Marelli, MD, FRCP(C), FACC
Assistant Professor of Medicine,
McGill University,
Montreal, Canada
"... 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.
References
-
Moller JH, Taubert KA, Allen HD, Clark EB, Lauer RM.
Cardiovascular health and disease in children: current
status: a Special Writing Group from the Task Force on Children and
Youth, American Heart Association. Circulation. 1994;89:923–930.[Abstract/Free Full Text]
