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Ann Thorac Surg 1995;59:631
© 1995 The Society of Thoracic Surgeons

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Review of Recent Books

Noninvasive Imaging of Congenital Heart Disease: Before and After Surgical Reconstruction

See also page 626.

Noninvasive Imaging of Congenital Heart Disease: Before and After Surgical Reconstruction, authored by Drs Alvin J. Chin and Mark A. Fogel, is a significant work that demonstrates the utility of echocardiography (and magnetic resonance imaging) for evaluating a patient with congenital heart disease before and after palliative or corrective operations. The 400-page text is illustrated extensively with many examples of the use of echocardiography and magnetic resonance imaging to make accurate diagnoses of complex congenital malformations preoperatively and then evaluate the anatomic and physiologic result after surgical reconstruction. Unstated is the fact that these techniques now are able to provide much of the information previously available only with cardiac catheterization and angiography.

With regard to echocardiography, Dr Chin focuses on two developments that have revolutionized the application of ultrasound: popularization of the subcostal window as the starting point of choice in the newborn and the development of Doppler color flow mapping instrumentation. Increasingly these advances have allowed cardiac surgeons to proceed with complete intracardiac repair in infants with very complex diagnoses that 10 years earlier were operated on only after complete cardiac catheterization. The two-dimensional echocardiogram illustrates the anatomy and the color Doppler flow demonstrates the physiology. The approach to the chapters is organized in a ``segmental fashion'' drawing on the Van Praagh classification scheme, which has become very popular at many congenital heart centers.

In addition to the chapters on echocardiography, there is a section on preoperative and postoperative magnetic resonance imaging by Dr Fogel. Magnetic resonance imaging is useful particularly for evaluating extracardiac structures such as vascular rings and extracardiac conduits. The three-dimensional magnetic resonance imaging reconstructions with different colors for different structures and comprehensive labeling are particularly state-of-the-art and visually effective.

The strong points of the book are the multiple excellent illustrations covering a wide range of complex congenital heart defects. An example of the complexity are the echocardiograms of the thoracoabdominally conjoined twins operated on at the Children's Hospital of Philadelphia in August 1993. Many of the echocardiograms are accompanied by either standard angiograms or photographs of pathologic specimens. There are invaluable tables of normal ranges for various intracardiac dimensions of fetal echocardiograms. A minor problem with the organizational system of the book is that the text and the pictures are separated in each chapter. This encourages one to bypass the text and simply look at the excellent illustrations. Transesophageal echocardiography, which is used increasingly intraoperatively to assess the postoperative result immediately, is not discussed.

This is definitely an advanced text, and because of the relatively high degree of sophistication required for the correlation of echocardiography with the anatomy of congenital heart disease, this book will be most useful for pediatric cardiologists, pediatric cardiac surgeons, and pediatric cardiac pathologists. It will not be as useful for peripheral subspecialists such as pediatric cardiac anesthesiologists, neonatologists, and even pediatric intensivists because of the detail and complexity of the cases that are presented.

The trend in congenital heart disease diagnosis is toward more and more reliance on the use of noninvasive imaging techniques such as echocardiography and magnetic resonance imaging. This comprehensive book should be required reading for all pediatric cardiologists specializing in noninvasive imaging techniques.

Chicago, Illinois

Footnotes

By Alvin J. Chin, MD, and Mark A. Fogel, MD Armonk, NY, Futura, 1994 400 pp, illustrated, $128.00

Reviewed by Carl L. Backer, MD

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