Book Review

Primary Pediatric Cardiology

N Engl J Med 1996; 334:337-338February 1, 1996

Article

Primary Pediatric Cardiology
Edited by Michael H. Gewitz. 482 pp. Armonk, N.Y., Futura, 1995. $85. ISBN: 0-87993-560-X

When I told one of my colleagues in adult cardiology that I was reviewing Primary Pediatric Cardiology, he asked, “Is there such a thing?” As the editor and coauthor of this book, Dr. Michael Gewitz, indicates in his preface, for the practicing pediatrician there is need for a textbook somewhere between the extensive books written for pediatric cardiologists and the handbooks for residents. Gewitz suggests that the chapters in the book are distillations of bedside teaching by pediatric cardiologists, whose content and style may help the pediatrician or family physician to deal with questions about pediatric cardiology. As a guiding concept, this philosophy is probably valid. However, because of difficulties with organization, presentation, and editing, Primary Pediatric Cardiology is hard to read and falls short of its noble purpose.

The organization of the book is jumpy. For instance, the first chapter is entitled “Risk Factors for Congenital Cardiac Malformations,” and the third is “Syndromes in Congenital Heart Disease.” “Introduction to the Clinical Examination” sits between the two chapters about epidemiology and causation. As individual reference chapters, the sections are uneven, and a better overall organization would have smoothed out the unevenness.

Together, the first and third chapters give a good overview of the causes of congenital heart disease and the associated conditions. The discussion of the clinical examination in chapter 2 is worthwhile and interesting. The chapter on the electrocardiogram may contain more detail than necessary for the practicing pediatrician or family physician. For both the noncardiologist and the cardiologist, the “bisecting perpendicular” approach seems more cumbersome than drawing a vector with leads I and aVF.

Chapter 5, on pediatric echocardiography, includes nice diagrams of the orientation of certain echocardiographic views with respect to congenital heart anatomy, but then does not use those orientations in some subsequent figures. Much of the discussion in this chapter is not germane to primary care and contains more detail than is needed.

The book makes some statements that are not generally accepted. For example, although sedation may not be required in all infants and young children, it is not always true that “the potential complications of sedation can be avoided in all but those few very unruly patients with complex disease.” The complete examination of the posterior and cephalad structures in the suprasternal-notch view can often be carried out adequately only with mild (and safe) sedation with oral chloral hydrate. The performance of balloon atrial septostomy in the neonatal unit is not standard, and occasional sweeping statements are not justified, such as this one: “The anatomic information obtained [by echocardiogram] is nearly always superior.”

Chapter 6, “Congenital Heart Defects: Acyanotic and Cyanotic,” is well organized and discusses information that should be widely known and appreciated by primary care physicians. Chapters 7 and 8, on catheterization and surgery, are also very good. In the latter, the figures are excellent overall. However, it is not now, nor has it been, standard to tell parents that “they should not allow the child to become upset because this may precipitate a cyanotic spell. Furthermore, if they do not respond appropriately to the spell, it may result in brain damage or death.”

The chapter about acquired cardiac diseases might have mentioned that balloon dilation in the catheterization laboratory is an excellent alternative to surgery in cases of late progression to mitral stenosis. The book says that transvenous pacing is mandatory for complete atrioventricular block associated with myocarditis, but the transcutaneous pacemaker has obviated the need for transvenous pacing in many patients.

The appendix is well written and has a level of detail that most of the chapters should have aimed for. The overall purpose and plan of this textbook are excellent, but in this inaugural edition it does not fully realize its promise.

Martin P. O'Laughlin, M.D.
Duke University, Durham, NC 27710