There are growing questions regarding the safety, quality, risk management, and costs of PCC teams, their training and preparedness, and their implications on the welfare of patients and families. This innovative book, authored by an international authorship, will highlight the best practices in improving survival while paving a roadmap for the expected changes in the next 10 years as healthcare undergoes major transformation and reform. An invited group of experts in the field will participate in this project to provide the timeliest and informative approaches to how to deal with this global health challenge. The book will be indispensable to all who treat pediatric cardiac disease and will provide important information about managing the risk of patients with pediatric and congenital cardiac disease in the three domains of: the analysis of outcomes, the improvement of quality, and the safety of patients.

In recent years, The impact of the inflammatory response in cardiovascular surgery has been a focus of much attention within the field of cardiac surgery. Despite that, scientific research on the topic is still lacking in the health science literature. To develop the bank of information available to all involved in the field, the Editors of this book have assembled a group of leading experts to investigate the most current and exciting topics related to inflammation and cardiovascular surgery. As such Inflammatory Response in Cardiovascular Surgery is vital reading for all involved in the management of cardiovascular surgical patients, such as cardiovascular and transplant surgeons, anesthesiologists, intensive care physicians, cardiovascular and vascular fellows, and researchers.

New Techniques for Thoracic Outlet Syndromes presents in a comprehensive format an up-to-date, state of the art reference that physicians can use in consultation to properly treat patients using the resources that modern medicine offers. This book offers the newer surgical approaches that have been developed during the past 30 years. Some of these techniques are modification of operations that were proposed previously but were not fully affective and left many patients suffering with permanent disability. This textbook is a compendium of the proper management of these patients that cannot be found in isolated reports of literature. The neurogenic-arterial thoracic outlet syndrome section covers how to diagnosis the illness using the proper tests, therefore eliminating the use of expensive, uncomfortable and inconvenient tests. The text is organized in three basic sections that cover all the aspects of the thoracic outlet syndromes. The first section addresses the neurogenic-arterial type, with the pertinent subsections: symptoms, diagnosis. A list of the useful tests is provided to make a correct diagnosis of this syndrome. This is followed by the sections on treatment, using the surgical approaches with historical aspects and evolution of the operations proposed. The second section involves the venous thoracic outlet syndrome divided into the corresponding subsections comprising: symptoms and physical findings, etiology, diagnosis. This section also includes a list of the usual tests to make the proper diagnosis. The last section of this text is dedicated to the presence of cervical ribs and their classification of the different types that occur, and also the proper surgical treatment when fusion of the upper ribs is present. New Techniques for Thoracic Outlet Syndromes offers the current, acceptable and most effective methods to handle thoracic outlet syndromes. It will be of great value to thoracic surgeons, vascular surgeons, interventional radiologists as well as fellows and residents in training for cardiothoracic and vascular surgery.

Computational Cardiovascular Mechanics provides a cohesive guide to creating mathematical models for the mechanics of diseased hearts to simulate the effects of current treatments for heart failure. Clearly organized in a two part structure, this volume discusses various areas of computational modeling of cardiovascular mechanics (finite element modeling of ventricular mechanics, fluid dynamics) in addition to a description an analysis of the current applications used (solid FE modeling, CFD). Edited by experts in the field, researchers involved with biomedical and mechanical engineering will find Computational Cardiovascular Mechanics a valuable reference.

In the last decade, technical improvements have changed the inventory of many research laboratories. New techniques and discoveries continuously give rise to observations that result in the de?nition of new research objectives. In the past, - search departments were clearly demarcated. Nowadays, technology that is shared by all lines of research stimulates convergence of research interests. This also - plies to cardiovascular research. Vascular occlusive disease is now core business for researchers employed by cardiology, vascular surgery, vascular medicine, - diology, cell biology, chemistry, physiology, and many other areas. Knowledge on actual research development is shared by researchers with different skills. It is sometimes dif?cult to acquire expertise when a researcher feels his experimental work could be improved by introducing a new research technique. In this book, the investigator will ?nd an overview of recent developments that are relevant for research in general but cardiovascular research in particular. Genomics, p- teomics, microarray, RNAi, stem cells, and progenitor cells are just some phrases that have become increasingly prevalent in literature in the last few years and that are recognized by many, but are fully understood by few. In this book, experts share the most appreciated new developments and techniques in cardiovascular research. We hope that this book will help the reader who is working in the ?eld of cardiovascular research to understand and critically appreciate current research, and that it will help improve the quality of experimental work. Dr G.

Esophageal cancer remains both a life-threatening disease and an everyday challenge for both patients and surgeons. Controversies regarding its management are prevalent, creating con- sion and uncertainties. Preoperative mortality and morbidity, limited overall and disease-free survival, and dismal prognosis make decision making regarding the choice of management dif? cult. Prof. Puntambekar is an enthusiastic surgeon, full of energy and inspiration. This young colleague offers contemporary possibilities for management of esophageal carcinoma. Prof. Cuesta is an experienced surgeon working in Europe. These two authors have compiled their work in this atlas and enrich the reader with experience encompassing two different c- tinents. This book is an update of novel surgical techniques of combined thoracoscopic and laparoscopic approach in minimally invasive management of esophageal carcinoma. Prof. Puntambekar's outstanding experience and expertise in this ? eld is fully illustrated in this book in a step-by-step description of the operative procedures. This book should be regarded as a landmark for the surgical management of esophageal carcinoma. The book is distinctive and the technical steps are original, re? ecting a deep knowledge of the regional anatomy and a unique ability of visual and operative orientation.

This book is driven by the considerable progress made by novel imaging techniques in understanding the pathophysiology and evolution of aortic disease and its diagnosis. Despite the lack of symptoms in stable conditions, most aortic diseases have a high morbidity and mortality. New therapeutic strategies such as endovascular treatment and surgical techniques have appeared to improve conventional surgery in advanced phases of the disease, but until recently, medical treatment has focused on the control of cardiovascular risk factors using beta-blockers to reduce aortic wall stress by reducing blood pressure and heart rate. Pharmacotherapy in Aortic Disease updates the reader on the new medical treatment that are changing the natural history of these diseases. Leading experts have created a critical in-depth, yet concise, analysis of the available medical treatments for different aortic disease entities. Both basic research studies and clinical trials discussed in this book serve as a base for improving therapeutic management, delaying the need for surgery, and prolonging survival in these patients.

This pocket manual is a quick-reference handbook for general thoracic surgery. It is organized into 9 chapters providing a concise, yet inclusive list of the most common pathologies seen in thoracic surgery: pre-operative evaluation, peri-operative care, lungs and airways (divided into 3 separate sections to cover the vast number of topics), pleural disorders, mediastinal disorders, chest wall disorders, thoracic trauma, and benign and malignant esophageal disorders. The content of each chapter was specifically structured to make the handbook a high-yield reference that includes numerous management algorithms, flow diagrams, tables and images. Unlike a comprehensive textbook, paragraphs are kept at a minimum and the written material is presented using lists and bullet points to facilitate learning and retention. More importantly, the content is evidence-based and highlights the various controversies in the field. The Pocket Manual of General Thoracic Surgery is an irreplaceable educational tool amongst trainees and practicing physicians.

Surgical options for the treatment of degenerative, ischemic, inflammatory, and functional mitral valve diseases have expanded greatly in recent decades. Still, a dilemma exists with employing prosthetic mitral valves - in that mechanical valves exhibit good durability but require anticoagulation versus the unpredictable durability of biological valve prostheses. Over the past few years, it has become clear that reconstruction of the mitral valve with autologous tissues effectively addresses this dilemma, with no need for anticoagulation and excellent durability, combining the best qualities of both prosthetic options without the disadvantages. Moreover, newer repair strategies, such as autologous pericardial leaflet augmentation and artificial choral replacement have expanded reparative approaches into virtually all pathologies, with excellent long-term results as compared to prosthetic valve replacement. At present, mitral repair is becoming the dominant procedure for treatment of virtually all patients with mitral valve disease. This book is designed to illustrate contemporary and sometimes diverse surgical techniques for various types of mitral valve repair with contributions from many of the leaders in the field. Mitral Valve Repair and the recently published Aortic Root Surgery are book publications arising from the Berlin Heart Valve Symposium 2008 entitled " The Biological Solution". The Mitral Valve Repair session was postponed to June 2009 and was featured as the Berlin Mitral Valve Symposium at the joint meeting of the Society for Heart Valve Diseases and the Heart Valve Society of America in Berlin. The book contains a collection of proceedings on current techniques and outcomes of mitral valve repair by many of the experts in this field which provide an authoritative reference source for cardiac surgeons, family practitioners and clinicians.

Minimally invasive surgical techniques have the minimally invasive procedure allow far made a significant impact in lowering morbidity modifications in anesthetic technique. The and mortality and in changing the indications basics of this endeavor are weIl covered in this for operative surgery in the abdomen. Only section. recently have these minimally invasive tech- The basic techniques of thoracoscopic surgery niques been applied to the diseases of the tho- were developed in various diagnostic maneu- rax. The standard posterior lateral thoracotomy vers. It was this initial diagnostic application of infamous for its post-operative pain and atten- thoraeoseopy whieh aIlowed these teehniques to dant complications, is already being replaced in be developed and further therapeutie applica- a large number of situations by minimally inva- tions to be forwarded. This text nicely illustrates sive thoracoscopic techniques. eurrent diagnostie techniques and their applica- This text by Gossot, Kleinmann and Levi pro- tion. vides basic information required for surgeons In addition, the most commonly applied thera- interested in approaching the most common peutie proeedures in the pleura, lung and eso- diseases in the ehest utilizing thoracoscopic phagus are weIl eovered as are their indications techniques. The text is a well organized attempt and potential eomplications.

Much has been written about reperfusion injury in the past decade but unfortunately the information has been generally presented in the form of original specialist papers and little if any integral publication exists on the topic, summarising and analysing the clinical impact of the condition and its management. The pathophysiology and molecular mechanisms of reperfusion injury are complex and, regarding diagnosis, individual diagnostic techniques have been proposed but without a proper assessment of the relative values of these methods. A publication dealing with integral diagnostic strategies would be welcome by the managing physician. Management of the condition is also problematic, as strategies that appear to work in the experimental models do not translate into beneficial interventions in patients. There is a need for these issues to be addressed and discussed in a monographic fashion. Management of Myocardial Reperfusion Injury will tackle these issues in a modern and systematic way and the information will be delivered in a fashion that will be appealing to the reader.

Cardiovascular fluid mechanics is now used as a tool in determining diagnosis, treatment, and prognosis by physicians and surgeons working in the fields of cardiology and angiology. The text is based on a considerable amount of clinical and experimental data on blood flow in the heart and large vessels obtained using various methods such as ultrasound pulsed Doppler velocimetry (including Doppler color flow imaging), catheter-tip electromagnetic velocimetry, hot-film anemometry, and laser Doppler velocimetry. The book will introduce medical researchers and clinicians to this rapidly developing field and allow them to apply the knowledge and the methods of fluid mechanics to practical medicine.

This book will provide both an evidence base and practical recommendations for the treatment of patients with congenital heart disease. It will be a resource to all health care providers, including pediatric cardiologists, pediatric intensivists, pediatric heart surgeons, fetal specialists, maternal fetal medicine specialists, neonatologists, nurses, advanced practice nurses, in addition to trainees in the field. It will summarize world knowledge on the topic of heart failure in patients with congenital heart disease. It will provide an in depth analysis of the current methods of diagnosis and treatment of heart failure. Now that surgical results are at record success rates, more patients with congenital heart disease are surviving, and thus at risk for sequelae from their disease, including heart failure. It will provide evidence based and practical recommendations to the practitioner for the management of heart failure signs and symptoms.

A comprehensive review of all known immune mechanisms for medically important fungal pathogens from the organ perspectives of the human body. This authoritative guide is organized by organ system, as one particular fungus can have several different effects.

An Atlas of Radioscopic Catheter Placement is unique, and has been conceived as a handy reference guide for students, interventional cardiologists, nurses and electrophysiology technicians. It includes plenty of schemes and X-ray images, and every EP correct catheter positioning is explained step by step through detailed descriptions of the necessary manoeuvres, including some "trucks" brought about by the experience.

Cardiothoracic Surgery in the Elderly: Evidence Based Practice is an important and timely book that reflects the thoughtful work of pioneers in geriatric surgery. It encompasses their knowledge related to geriatric surgery, and their reflections and guidance on the rapidly accumulating knowledge related to improving the health and surgical care of seniors. This book provides a scholarly review of the constantly expanding knowledge base about cardiovascular and thoracic surgery in seniors. The book follows a logical sequence covering general aspects of care, cardiac surgery and thoracic surgery. Chapters are focused on common, devastating and often missed complications of surgical care in the seniors. These include delirium, depression, pressure sores, functional losses, incontinence, volume depletion and asymptomatic or atypical complications -myocardial infarction, post-operative diarrhea, urinary track infections and pneumonia. Each is expertly reviewed. Strategies to help the surgeons and the surgical team anticipate, recognize and effectively prevent or manage such problems are discussed and the evidence basis for such strategies is provided. Cardiothoracic Surgery in the Elderly: Evidence Based Practice is particularly timely and the first to review the substantial body of knowledge that has been developed in recent years related to geriatric cardiothoracic surgical problems. It catalogs well the expanding knowledge basis for achieving successful surgical outcomes in the very old. It provides a most useful resources for cardiovascular thoracic surgeons in training and those already in practice.

Despite the significant decline in heart disease mortaht>' rates over the last 25 years, heart failure has remained a significant problem. We are now confronted with large numbers of terminally ill patients for whom conventional therapies for heart failure have been exhausted and for whom repeated hospital visits are necessary. There now is a major thrust towards a management strategy which embraces a comprehensive approach including vigorous preventive measures and earlier surgical interventions. This book outlines the major surgical options for the treatment of heart failure and brings together a very broad base of opinions with contributions from several outstanding individuals. With the improved knowledge and techniques to control rejection, transplantation has become the central pillar in the surgical management of this group of patients. Unfortunately, because of limited donor supply the teclmique cannot be applied to large numbers of patients. A great deal of excitement, however, exists in the potential for xenotransplantation as a supplement to homotransplantation. The use of cardiac assist devices has become a reality with several hundred LVADS and BiVADS implanted throughout the world and cardiac replacement with total artificial hearts continues to be used successfully as a bridge to transplantation. We are on the thieshold of the broad application of assist devices to provide prolonged relief of heart failure and restore patients to an ambulatoiy home environment and hopefully return to the work force in significant numbers.

The aim of this book is to focus on the important relationships between the heart and the brain in health and disease. The brain and nervous system may cause or influence heart disease, e. g. , by causing arrhythmias or modi- fying the response to ischemia. Disorders of the heart and circulation may cause brain damage, e. g. , by releasing emboli resulting in cerebral infarc- tion. Furthermore, both the brain and the heart are frequently targets of the same disease process. The heart and brain have electrophysiologically active cells, which may respond in similar ways to diseases and various interventions. Finally, many drugs affect both the brain and the heart, and drugs used for heart diseases usually have side effects on the brain and vice versa. With today's increasing subspecialization in medicine, we feel the time has come to present a book that integrates basic and clinical aspects of cardiology, neurology, cardiovascular surgery, and neurosurgery. We hope this cross fertilization will broaden horizons and advance both understand- ing and practice. This book is based on a symposium held at the University of TromS!/l, Norway, 24-27 June 1987, organized by Ilmar A. Sulg, Knut Rasmussen, Svein Ivar Mellgren, Dag S!/lrlie, and Helge Refsum of the Departments of Clinical Neurophysiology, Medicine, Neurology, Surgery, and Physiology, respectively. Weare grateful to the distinguished group of contributors for not only outlining their pioneering studies, but also describing their recent work and indicating important possibilities for the future.

Cardiovascular disease is the leading cause of morbidity and premature death of modern era medicine. It is estimated that approximately 81 million people in the United States (US) currently have one or more of the many forms of cardiovascular disease, resulting in 1 in every 2.8 deaths, or 900,000 deaths per year. 40% of all deaths in Europe are a result of cardiovascular disease in people under the age of 75. Aneurysms form a significant portion of these cardiovascular related deaths and are defined as a permanent and irreversible localised dilation of a blood vessel greater than 50% of its normal diameter. Although aneurysms can form in any blood vessel, the more lethal aneurysms develop in the cranial arteries, and in the thoracic aorta and abdominal aorta. Frequently aneurysms are undetected and if left untreated may eventually expand until rupture with very high levels of morbidity and mortality. The biomechanics and mechanobiology of aneursymal diseases are not fully understood and this monograph aims to provide new insights into aneurysm aetiology and behavior based on the most recent biomechanics research related to this important topic. The contributors to this volume bring together a unique blend of expertise in experimental, computational and tissue biomechanics relating to aneurysm behavior and enable the reader to gain a fresh understanding of the key factors influencing aneurysm behavior and treatment. Biological risk factors such as tobacco smoking, sex, age, hypertension, family history and mechanobiological risk factors such as aneurysm geometry and shape as well as mechanical properties of the diseased tissues are considered in detail as are many of the diagnostic and treatment options.

Cardiac performance is regulated not only by cardiac muscle properties but also by several other factors, including those associated with the neurohumoral system and the mechanical characteristics of the peripheral circulation. New information con cerning these regulatory factors has furthered our understanding of the pathophysi ology of cardiac dysfunction. However, controversy remains, along with a need to integrate these multidisciplinary findings. It was with this in mind, together with my continuing interest in the response of the normal and diseased heart to variations in loading conditions, that the satellite symposium entitled "Interactions Between Car diac Function and Vascular Dynamics" was organized and dedicated to my mentor, Dr. T. Takishima. The symposium was held in Fukushima, Japan, in 1992 following the Tenth Inter national Conference of the Cardiovascular Systems Dynamics Society in Kobe, Japan, which was organized by the then president of the society, Dr. Masatsugu Hori. The Fukushima symposium and the Kobe conference were stimulating and informative. To commemorate these events, Dr. Hori, Dr. Janicki, and I decided to publish this book. It covers topics that were presented then as well as pertinent new material. As a result, the book includes not only updated reviews but also up-to-date findings that were not considered at the two scientific sessions. The high level attained in this book is due to the outstanding contributions from internationally renowned scientists. This final product of their efforts should prove to be a valuable source of information to the reader."

How to face 'the faces' of cardiac pacing represents an editor's compiled selection of lectures on cardiac pacing and electrophysiology. Electrical stimulation of the heart is an ever-changing and, at times, explosive field. The number of implanting centres is growing tremendously and pacing is not exclusively confined to arrhythmologists. Therefore, the editors attempted to organize a course being both practical in daily clinical management and instructive in understanding technical concepts. The glossary of terms have to be clearly understood before one is able to interpret the complex electrocardiograms of DDD and especially DDDR pacemakers. Those electrocardiograms have to be approached in a system atic way, using a step-by-step analysis. The main clinical symptom requiring pacemaker implantation is syncope. It cannot be over-emphasized that syncope is a clinical diagnosis merely based on history and physical examination. The organization of a pacemaker follow-up clinic depends on local facilities and needs. The effectiveness of pacing controls markedly increases when using a systematic approach. Repeated optimal adjustment of pro grammable functions is part of the control. Antiarrhythmic drugs are loosing popularity in the treatment of tachy arrhythmias. Nonpharmacologic treatment (antitachypacing, implantable defi brillators and antiarrhythmic surgery) at the present time have definite indications, probably expanding in the future. When complexity in electronic devices increases, repercussions on ex penses, either by the government or social and private insurances, needs consideration."

This book is the first of its kind - a comprehensive reference for anesthesia and perioperative clinicians involved in aortic surgery. With a primary focus on anesthesia for various aortic surgical procedures, including endovascular aortic surgery, the title also provides expanded coverage of CNS monitoring and protection, intraoperative transesophageal echocardiography, renal and spinal cord protection during surgery, management of aortic trauma, and postoperative care. Written by top cardiac anesthesiologists, surgeons, and intensivists, this indispensable reference provides everything you need to know about the burgeoning field of aortic surgery in one handy volume.

Cardiac surgery has developed dramatically since the first open-he art operations were performed in the mid 1950s. Although the improvement of surgical technique, extracorporeal circulation, and postoperative management has contributed to a marked reduction of morbidity and mortality, the development of cardiac surgery to its present state would not have been possible without blood substitution by homologous donor blood. Only 20 years ago, open-heart operations required an average of 8 units of blood preserves. The excessive need of donor blood in those early days was mainly due to premature surgical technique, insecure control of anticoagulation, severe blood trauma by extracorporeal circulation, and the lack of retransfusion technologies that would have allowed the reuse of shed mediastinal blood. The introduction of new technologies, such as normovolemic hemodilution, in traoperative autotransfusion, postoperative return of shed mediastinal blood, and predonation of autologous blood has greatly reduced donor blood requirements. At present the majority of routine coronary artery surgical procedures can be performed without any blood transfusion. Blood loss, however, may be considerable in patients undergoing complex valve surgery or reoperations, as they often require several units of transfused blood. Blood conservation has now become an area of major interest for the cardiac surgeon. This increased concern is caused by infectious complications of blood transfusion, in particular hepatitis and, more recently, AIDS."

Liposuction began as a contouring procedure but has evolved into the treatment of obese patients, gynecomastia, ptosis, macromastia, and even patients who have complications from heart disease or diabetes. Other disorders such as axillary sweat hypersecretion, lipomas, and angiomas are also potential disorders that may be treated with liposuction.

Physicians performing liposuction must be adequately trained and experienced in the potential and actual complications before attempting to perform liposuction. Patient safety is the most important aspect of all surgeries, but especially of cosmetic surgery, which is an elective procedure.

New technology helps improve results but experience, care, and skill of the cosmetic surgeon is necessary to obtain optimal results that satisfy the patient.

The contributors to this book have spent time and effort presenting the cosmetic and plastic surgeon as much information as possible on the techniques and uses of liposuction for cosmetic and non-cosmetic surgery purposes.

primary goal of all forms of therapy is not just prolonging life, but improving the quality of life, has forced analysis of what constitutes quality of life, a concept whose structure pervades all walks of life and eludes definition. Global well being, happiness, morale, vitality, fullness of social life, and satisfaction must be integrated and assessed for the effects of the disease and the therapy, in the context of specific personality traits, attitudes to life, family situation, and socio-economic and political freedom. A growing inter est in research on this subject has led to a clearer understanding of the components which come to determine quality of a patient's life, and how they can be measured in a reproducible manner so that valid comparisons can be made. Keeping these recommendations of analysing quality of life within the context of patients who have undergone open heart surgery, it seemed appro priate to me to separate the influence of various forms of open heart surgery into five aspects of life which can comprehensively reflect the quality of life outcome of the operation. These five 'components' are (1) Physiological state, which summarises the traditionally reported incidence of operative mortality and morbidity, objectively and subjectively measured physical ca pacity, and the residual symptoms, treatment and long-term survival. (2) Intellectual functioning relates to the psychoneurolgocial deficit in memory, reasoning or judgement because of cerebral microembolism and hypo perfusion during cardiopulmonary bypass.