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Book Reviews
Valvular Heart Disease: Comprehensive Evaluation and
Treatment, 2nd Edition
Edited by William S. Frankel and Albert N. Brest
F. A. Davis Company, Philadelphia ( 1993)
339 pages, illustrated, $80.00
ISBN: 9-8036-3792-6
Nowadays, valvular heart disease is not a leading field. It has
been displaced by the rising interest in ischemic and degenerative
heart involvement. Papers relating to valvular heart disease are
scarce, and as they are distributed in different publications, state-
of-the-artknowledge in this area is difficult to come by. The last
book of Brest’s collection solves this problem. It actualizes in a very
comprehensivefashion the etiology, diagnosis, surgical indications
and techniques, and prognosis of valvular heart disease.
The book is very readable. Basic concepts are clearly explained
in brief chapters. There is an extensive bibliography on each sub-
ject; however, this must not be confused with a bibliographic sum-
mary nor with a simple review of new papers, two formats which
are in mode just now.
The number of topics treated is very large. The two first chap-
ters describe new knowledge of the etiology of valvular heart dis-
ease: Chapter 1 treats rheumatic fever and its increasing diagnosis
in several regions where the disease was practically nonexistent a
few years ago; Chapter 2 addresses the congenital origin of val-
vular heart disease. The chapters that follow are dedicated to diag-
nostic techniques, especially echocardiography and magnetic res-
onance imaging. There is an extensive description of the transe-
sophageal echocardiographic approach and its importance in valv-
ular regurgitation and prosthetic dysfunction.The next section of
the book undertakes some specific clinical considerations in valvu-
lar heart disease: the management of arrhythmias; the diagnosis,
management, and prophylaxis of endocarditis; and the problems
of the valvular heart disease in the elderly. The clinical section ends
with a chapter that considers the timing of surgery for patients with
different types of valvular heart disease. Finally, the last part of the
book talks about the management of valvular heart disease. It re-
views the state of the art of valvular prostheses, mitral valve re-
construction, and percutaneous valvuloplasty.In the chapter on me-
chanical prostheses, the authon discuss the problem of strut k t u r e
of the disk Bjork prostheses extensively, which could be very use-
ful for clinicians with patients asking about this topic.
The number of personal experiences related in each chapter de-
serves mention. For instance, in the chapter “Tuning of Surgery for
Valvular Heart Disease,” the authors propose some practical algo-
rithms based on their everyday experience. Although these algo-
rithms could be similar to others previously described, use of the
term “symptomaticpatients” places the patient in New York Heart
Association functional class Lu or higher. However, other authors
leave to the reader’s imagination (and subjective interpretation)
how symptomatica patient should be in relation to the timing of
surgical valve replacement. In this way, the authors almost always
pinpoint their opinions on controversial topics.
The book has few negative points; the majority of these are due
to editorial decisions. First, all color (and some black and white)
figures are grouped in a few plates placed far from the point ofref-
erence to the illustration, making it difficult to establish the relation
223
between figures and text. Another problem could be that the bib-
liography is not as current as the reader might desire: only a few ar-
ticles are more recent than 1990.This fact is not as important for
chaptersdevoted to etiology or management which depend on ac-
cepted knowledge, but for quickly evolving fields such as diag-
nostic techniques, an up-to-date bibliography is essential. How-
ever, these limitations are not sufficient to reduce the high interest
ofthe book.
In conclusion, this book is not only a good review of papers that
have been published on valvular heart disease (it contains more than
1200references), but it is an excellentguide to the correct diagno-
sis and management of patients with valvular disease. In my opin-
ion it must be considered a classic and should be placed in cardiol-
ogy libmies near other classic books on valvular heart disease, such
as the Alpert and Dalen or the Paul Wood books.
Xavier Borras, M.D.
Cardiac Department, Hospital Sant Pau
Barcelona, Spain
Cardiac Surgery, 2nd Edition
By John W. Kirklin and Brian G. Bmtt-Boyes
Churchill Livingstone, New York (1 993)
1780 pages, illustrated, $250.00
ISBN: 0-443-08845-4
This remarkable textbook now in its second edition, remains a
seminal achievement in the field of cardiac surgery. Both of the au-
thors are world renowned for their expertise in this area,and for this
edition they have collaborated closely with three other well known
cardiovascular surgeons to present the most cogent, up-to-date, and
rational scientific surgical approach for treatment of cardiovascu-
lar diseases of the chest that is available for reference. It is indeed
ambitious to attempt to summarizeall the current knowledge and
understanding in a field where dramatic changes and therapies
evolve on a rather routine basis, but these individuals have suc-
ceeded admirably.
For the second edition text has been expanded to nearly 1800
pages with extensive revision and rewriting of all chapters. The
book‘s overall organization remains the same with the same num-
ber of chapters devoted to general considerations,ischemic heart
disease, acquired valvular heart disease, congenital heart disease
(the largest section),cardiac rhythm disturbances,miscellaneous
conditions,and thoracic aortic disease. Each chapter stands alone
as a nearly exhaustivetreatise of its particular subject with superb
illustrations,drawings, figures, and pathological photographs.A
number of operative procedures are clearly illustrated as in a sur-
gical atlas. In addition, the authors have provided sections on the
indicationsfor operation as well as the immediate and long-term
results for many of these procedures to aid clinicians in the deci-
sion-making process. This text will remain the standard in this field
for many years to come and will garner the admiration of genera-
tions of physicians who care for these patients.
Thomas H. Wareing, M.D.
Department of Surgery, Division of Cardiothoracic Surgery
Jewish Hospital of St. Lewis
St. Louis, Missouri
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