Ann Thorac Surg 1995;60:1254
© 1995 The Society of Thoracic Surgeons
Review of Recent Books
Current Therapy for Acute Coronary Ischemia
Edited by Harold L. Lazar, Mount Kisco, Futura Publishing Company, 1993, 295 pp, illustrated, $65.00
Robert M. Mentzer, Jr, MD
See also page 1250.
Recently, there have been many publications addressing myocardial salvage after ischemic injury and myocardial infarction during cardiopulmonary bypass. This book nicely integrates basic science principles and knowledge with critical care issues that are equally important to the basic scientist, clinical investigator, and clinician who deal with the problem of acute coronary insufficiency. The text is divided into 11 chapters that represent the views of 20 prominent scientists, cardiologists, and cardiothoracic surgeons.
The first chapter provides insight into the pathophysiology of ischemia and reperfusion and briefly introduces the concept of myocardial stunning and its underlying mechanism as well as potential therapies. The concept of ``preconditioning'' is introduced as well. Chapters 2, 3, and 4 review the role of thrombolytic therapy, coronary venus retrograde reperfusion, and angioplasty in treating acute coronary ischemia. The pathogenesis of the underlying disease, therapeutic options, outcome analysis, and the various treatment modalities are discussed. Chapter 5 reviews experimental animal and clinical studies that support the implementation of a myocardial protection strategy that can be used during cardiopulmonary bypass to salvage ischemic myocardium beyond the generally accepted 2-hour ischemic time period. Chapters 6 through 10 focus on surgical revascularization and mechanical support for the patient with acute myocardial infarction after failed percutaneous transluminal coronary angioplasty, refractory unstable angina, and acute pump failure. Chapter 11 addresses the clinical problems of cardiogenic shock after acute coronary ischemia or myocardial infarction. The emphasis here is on mechanical devices for temporary support to afford stabilization, diagnosis, and surgical correction, and as a bridge to transplantation. A brief review of the various devices is provided and the results of transplantation after mechanical circulatory support are discussed.
Overall, the text is well-written and informative. It more than adequately summarizes currently available information regarding the pathophysiology of acute myocardial ischemia and reperfusion, and the roles of thrombolytic therapy, angioplasty, surgical revascularization, mechanical assist devices, and transplantation in the management of patients with acute coronary insufficiency and its sequelae. The chapters are well illustrated, and the bibliography at the end of each chapter is designed to provide the reader with references for more extensive study. The editor is to be commended for emphasizing the issues surrounding the timing of angioplasty and the problems associated with predicting the outcome after revascularization of the patient with an acute myocardial infarction. The purpose of this book is not to provide the definitive statement on the appropriate approach to managing patients with acute coronary occlusion, but to update the readers' present knowledge base and to stimulate both basic and clinical scientists to address controversial areas. This book is most appropriate for practicing cardiologists and cardiac surgeons, as well as cardiologists and cardiac surgeons in the early stages of training who wish to have a better understanding of the pathophysiology, the availability of therapeutic options, and the controversies that are unique to the patient with acute myocardial infarction.
Madison, Wisconsin
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Ann. Thorac. Surg. 1995 60: 1250-1254.
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