Book Review

Mechanical Complications of Myocardial Infarction

N Engl J Med 1994; 330:1323-1324May 5, 1994

Article

Mechanical Complications of Myocardial Infarction
Edited by Tirone E. David. 246 pp., illustrated. Austin, Tex., R.G. Landes, 1993. $149. ISBN: 1-879702-67-3

Myocardial infarction due to coronary artery disease remains the leading cause of death in the Western world. Its mechanical complications are usually what kill people. This review of the pathology, diagnosis, and medical and surgical management of these complications, edited by a renowned cardiac surgeon, therefore remains timely.

This 250-page book, which is compact enough to carry in one hand and read at one's leisure, carefully summarizes an important topic without advancing new or controversial treatments or management strategies. After an introduction, the initial chapter is a complete discussion of the pathology and pathophysiology of myocardial infarction and associated mechanical complications. The book logically proceeds to the clinical presentation of myocardial infarction and complicating events. The diagnostic possibilities of echocardiography and cardiac catheterization are discussed. One important innovation is a chapter devoted to the management of the sequelae of myocardial infarction in the coronary care unit.

The surgical section of the book begins with a chapter on strategies to protect the myocardium during operation. This extensive review article would have been strengthened by a more forceful statement of the author's preferred strategy. The editor of the book is the sole author of the subsequent four chapters, which discuss the surgical management of myocardial rupture, left ventricular aneurysm, postinfarction ventricular septal defect, and ischemic mitral regurgitation. The book concludes with chapters on surgery for ventricular arrhythmias after infarction and on heart transplantation for mechanical complications of infarction.

This clearly organized book treats an important topic in a comprehensive and up-to-date fashion. Its illustrations are excellent. It is of a convenient size and thus can be used both as a reference work and a practical manual. It shares with other multiauthored books limitations in organization and consistency; it also shares with many of them a substantial price tag.

Finally, this book emphasizes the multidisciplinary nature of the modern care of patients with ischemic heart disease. It therefore will appeal to cardiac surgeons, cardiologists, cardiac anesthesiologists, and intensivists at all levels of training and experience who care for these patients. It is ideal for the library of a multidisciplinary heart center. Comprehensive treatises on specific topics such as this may also have an increasingly important role in the evolution of health care under managed competition.

Verdi J. DiSesa, M.D.
Medical College of Pennsylvania, Philadelphia, PA 19129