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编号:11328772
Pediatric Heart Failure
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     The timing of this textbook's arrival is perfect. The field of pediatric cardiology has evolved from a focus on early survival toward an emphasis on the long-term health of children with heart disease. The editors, who are respected leaders in this field, have provided a state-of-the-art reference — the first of its kind — on the subject of pediatric heart failure.

    The introductory chapter is a wonderful historical perspective by Abraham Rudolph. He reminds us of the difficulty in precisely defining pediatric heart failure. He quotes Alexander Nadas, who in his 1957 textbook stated that "it might well be to regard congestive failure simply as a clinical syndrome associated with heart disease." Rudolph goes on to highlight the important early advances that have been made in the understanding of heart failure.

    From these early advances, the reader's attention is turned toward the developmental differences between the fetal and neonatal cardiovascular systems. Important concepts are reviewed: the molecular basis for muscle contraction, the role of the neurohormonal system and cytokines in heart failure, and the genetic causes of some cardiomyopathies. In a somewhat uneven manner, the book returns to these concepts in the later, more clinically oriented chapters.

    The reader will find the clinically oriented chapters well organized and extensively referenced. The authors give a complete picture of the causes, pathophysiology, and treatment of heart failure in fetuses, neonates, children with congenital and acquired heart disease, and adults with congenital heart disease. Entire chapters deal with arrhythmia, right-sided heart failure, and coronary-artery abnormalities. As a testimony to the comprehensiveness of this textbook, two chapters are worth noting — one that deals with the nutritional aspects of pediatric heart failure and another that deals with the psychological aspects.

    This book bridges the gap between basic-science concepts and clinical care recommendations. A minor complaint is that the complex figures of subcellular interactions would have benefited from color presentation. Because the chapters are disease-oriented, the coverage of diagnostic testing and decision making regarding treatment is variable. There is little material on newer diagnostic techniques, such as Doppler tissue imaging, that are used in the assessment of pediatric heart function. The coverage of post-transplantation heart failure is excellent, but there is less discussion about when pediatric heart transplantation should be recommended.

    The strengths of this textbook overwhelm any shortcomings of a work in its first edition. It will instantly become the standard reference on the subject of pediatric heart failure. It belongs in the library of all training programs and isfor all those involved in the care of children with heart disease.

    Wyman W. Lai, M.D., M.P.H.

    Mount Sinai School of Medicine

    New York, NY 10029((Fundamental and Clinical)