Book Review

Congenital Heart Disease: Textbook of angiocardiography

N Engl J Med 1998; 338:270January 22, 1998

Article

Congenital Heart Disease: Textbook of angiocardiography
Edited by Robert M. Freedom, John B. Mawson, Shi-Joon Yoo, and Leland N. Benson, with contributions by four others. 1432 pp. in two volumes, illustrated. Armonk, N.Y., Futura, 1997. $275. ISBN: 0-87993-656-8

Improvements in the surgical and medical care of infants and children with congenital heart disease are one of the most spectacular medical success stories of the past quarter-century. Diseases such as simple D transposition, truncus arteriosus, and critical aortic stenosis are no longer highly efficient killers of infants; now nearly all children with these conditions survive, and the medical focus has shifted from decreasing mortality to improving the status of long-term survivors. Even the lesion most resistant to therapy, the hypoplastic left heart syndrome, has many survivors thanks to recent advances.

Central to these stunning successes is a broad and deep understanding of physiology and anatomy in the living child with congenital heart disease. This area of study defies oversimplification. Dozens of disease categories, each with its own specific subtypes and associations, require different treatment algorithms. Attention to detail yields rich rewards. No book better illustrates these principles than Congenital Heart Disease, edited by Robert Freedom and his colleagues, most of them from Toronto's Hospital for Sick Children.

Angiography in general (especially these stunning angiograms) is an ideal way to illustrate the principles and specifics of human cardiac anatomy. Each chapter starts with a balanced and concise treatise on the anatomical pathology. The central text is often a clinical discussion of variable quality and focus, but then come the angiograms, and oh, what angiograms these are! Collected over two decades, these are visually striking, clinically relevant, and anatomically instructive. Examples abound of rare but important conditions and could result only from a sustained effort at a large cardiac center.

Freedom is particularly well suited to this task. After anatomical training with Jesse Edwards and Richard Van Praagh, and a close working relationship with Robert Anderson, he largely succeeds in creating an anatomical terminology that fuses the best approaches from each of these schools of cardiac anatomy. Reflecting Dr. Freedom's clinical training by Alexander Nadas and Richard Rowe, the entire book exemplifies attention to detail and common sense.

In many ways, this textbook is likely to represent the apogee of an era. Most of these angiograms were obtained as part of diagnostic cardiac catheterization. By the end of the century, nearly all anatomical diagnoses will be made by echocardiography and the newly emerging technique of magnetic resonance imaging of congenital heart disease. The opportunity to obtain such wonderful angiograms will be largely lost, but thanks to Congenital Heart Disease, the opportunity to learn from these angiograms and to use them to continue to care for children with congenital heart disease will be preserved.

James E. Lock, M.D.
Children's Hospital, Boston, MA 02115