Book Review

Congenital Diseases of the Heart: Clinical-Physiological Considerations

N Engl J Med 2001; 345:1579November 22, 2001

Article

Congenital Diseases of the Heart: Clinical-Physiological Considerations
Revised second edition. By Abraham M. Rudolph. 808 pp., illustrated. Armonk, N.Y., Futura, 2001. $98. ISBN: 0-87993-471-9

Remarkable progress has been made in the understanding and management of congenital heart disease since the first edition of Congenital Diseases of the Heart was published 25 years ago. With the ability of cardiac ultrasonography to define the anatomy of cardiac defects with great precision, diagnostic cardiac catheterization is seldom required, and interventional catheterization has largely replaced diagnostic studies. Dr. Rudolph began his career in pediatric cardiology in a physiology laboratory, and he has contributed greatly to our understanding of fetal circulation, postnatal adaptation, and the pathophysiology of congenital cardiac defects. As an experienced clinician, he correlates the clinical features of various cardiac defects with the resulting pathophysiologic features. His understanding of the dynamic nature of cardiac defects from fetal life to adolescence is well presented and makes for a clear and interesting book.

The book is unique among the current textbooks of pediatric cardiology. First, it has a single author, and except for abundant schematic figures and a few tables, it has no illustrations. The first four chapters discuss our current knowledge of cardiopulmonary physiology. Chapter one deals with the fetal circulation and postnatal adaptation. Chapter two, on functional assessment, will certainly be helpful for trainees in cardiology. Details of pressure measurements, cardiac output, intravascular shunts, and dye dilution are presented clearly and concisely. Oxygen uptake and delivery are covered in chapter three, and chapter four reviews prenatal and postnatal pulmonary circulation. These four chapters will benefit neonatologists, perinatologists, and pediatric and adult cardiologists who seek a current understanding of cardiopulmonary physiology.

The next 14 chapters deal with specific cardiac defects. Each chapter follows a similar pattern. The specific lesion is discussed with regard to morphology, hemodynamics, and postnatal circulatory adaptation. The symptoms, physical examination, and diagnostic studies are presented clearly and concisely. Each chapter contains a section on principles of management, which includes the natural history and the therapeutic options. The book is easy to read and reflects the experience of an outstanding clinician who is also a renowned researcher.

The book does not attempt to be a comprehensive review of every cardiac anomaly but covers in detail the most common defects. It is a personal book, containing many clinical pearls and reflecting Dr. Rudolph's own views. Students, residents, and cardiology fellows are all fascinated by the spectacular technology of cardiac ultrasonography and Doppler studies but pay less attention to the pathophysiology resulting from the anatomical defects. Dr. Rudolph clearly shows how the clinical findings correlate with the anatomy and explains the physiological consequences. Cardiac ultrasonography is relegated to its rightful role as a very important and reliable diagnostic tool. A clear understanding of the dynamic nature of congenital heart disease, and how the clinical picture reflects the pathophysiology, places the clinical evaluation of the individual patient in proper perspective. For cardiologists trained in recent years, this book should be required reading.

Jacqueline A. Noonan, M.D.
University of Kentucky College of Medicine, Lexington, KY 40502
jnoonan@pop.uky.edu