Book Review

Congenital Heart Disease in the Adult

N Engl J Med 2002; 346:1677May 23, 2002

Article

Congenital Heart Disease in the Adult
By Welton M. Gersony and Marlon S. Rosenbaum. 304 pp., illustrated. New York, McGraw-Hill, 2001. $75. ISBN: 0-07-032909-5

Several decades ago, most patients with uncorrected or corrected congenital heart disease did not survive to adulthood. As a result, they were cared for almost exclusively by pediatricians and pediatric cardiologists. Cardiologists trained to care for adults as well as general internists encountered these disorders so infrequently that even a rudimentary knowledge of congenital heart disease was considered to be unnecessary. Nowadays, however, patients with congenital heart disease often survive to adulthood, making it imperative that physicians understand the anatomy, pathophysiology, therapy, and prognosis of the abnormalities that may be encountered in this growing population of patients. Ideally, such information would be succinctly and clearly presented in a well-organized format and supported by an abundance of figures that would clarify each abnormality. The book by Gersony and Rosenbaum does precisely this by offering a concise, yet reasonably thorough, discussion of the various kinds of congenital heart disease that physicians may encounter in adults.

The book is logically organized into sections devoted to acyanotic and cyanotic conditions. For each specific abnormality, the authors describe the clinical presentation, the findings on physical examination, and the results of noninvasive and invasive testing. Each chapter contains an abundance of radiographic, electrocardiographic, and echocardiographic images; in addition, superb cartoons depict each anomaly. The authors next describe the management of each condition and discuss the increasingly used percutaneous (rather than surgical) treatments for numerous types of intracardiac communication (such as atrial septal defect, ventricular septal defect, or patent ductus arteriosus) and valvular stenoses. They then recount the natural history of each abnormality, including specific issues that should be addressed in the months and years after percutaneous or surgical correction. The presentation ends with a brief summary containing easily understood algorithms for evaluation and management.

The third section of the book contains two chapters. The first deals with the care of pregnant women with congenital heart disease. As more women with uncorrected or corrected congenital heart disease succeed in becoming pregnant, they may seek care from a family practitioner, obstetrician, internist, or cardiologist. The numerous management issues that often arise in such cases are succinctly and logically discussed. The second chapter of the section reviews the genetic basis of many congenital cardiac abnormalities. Like the rest of the book, this chapter is not exhaustive, but it provides a reasonable overview as well as an abundance of references.

This monograph does not contain all the information that one might conceivably desire about a specific congenital cardiac abnormality. It is precisely designed not to be exhaustive. Rather, it is intended to be an easily accessible resource for the general internist (in training or practice) or the cardiologist without extensive training in congenital heart disease. It is undoubtedly successful in these terms. For such physicians, the patient with congenital heart disease can be intimidating and anxiety provoking. The design, style, and content of the book ensure that it will succeed in alleviating much of that intimidation and anxiety.

L. David Hillis, M.D.
University of Texas Southwestern Medical Center, Dallas, TX 75390