These congenital deformities, funnel or keel chest deformities, as well as Poland syndromes, affect a small group of patients who suffer from aesthetic rather than functional impairment. The wide variety of diagnoses and recommended therapies, mostly surgical procedures, can be very confusing for patients, their parents, physicians and surgeons. In recent years several techniques have been refined and developed to deal with these complex problems, and surgeons with different specialties have been operating on these deformities, mostly as lonely experts in their respective fields. This book should not be seen as an operation atlas but more as a compact survey of a small group of medical conditions and the need for flexible options for an individual therapeutic approach, based on the combined experience of different international specialists. Thus the book is designed for obstetricians, pediatricians, physicians and surgical specialists alike.

This comprehensive resource brings together the most current theories, evidence and best practice parameters for the use of nocturnal non-invasive ventilation (nNIV). Chapters focus on the application of acute and chronic nNIV in patients with cardio-respiratory disorders over a range of major medical settings. Updates on past and recent research in this field are highlighted. Authored by leading clinicians and investigators, Nocturnal Non-Invasive Ventilation provides practical and cutting-edge knowledge to physicians, researchers and allied health professionals on the front lines of treating cardio-respiratory and sleep disorders.

Principles and Practice of Interventional Pulmonology provides a comprehensive text covering all aspects of Interventional Pulmonology. Providing both pathophysiologic background as well as illustrated and clear instruction on how procedures ought to be performed, this text will be of great value to interventional pulmonologists, thoracic surgeons, surgical oncologists, and interventional radiologists.

Redo cardiac surgeries are challenging cases with a myriad of influential factors, ranging from the patient's pathology to the whimsy of the previous surgeon. Redo Cardiac Surgery in Adults, 2nd Edition clearly outlines practical approaches, surgical techniques, and management of associated conditions such as perioperative stroke and acute kidney function. It covers the spectrum of redo cardiac operations, including coronary artery bypass, mitral valve repair, reoperation for prosthetic mitral valve endocarditis, aortic arch reoperation, descending and thoracoabdominal aortic reoperation, and reoperations following endovascular aortic repair. All redo cardiac surgeries present a complex array of challenges beyond what the original procedure demands. This book, written by an outstanding group of prominent physicians, will give the reader the knowledge and tools to approach these cases with confidence.

Designed to provide a highly visual reference for surgeons and other members of the patient management team, Atlas of Intestinal Stomas is based on the 1967 gold standard text, Turnbull and Weakly's Atlas of Intestinal Stomas. Additions include chapters on anatomy and physiology, biliary stomas, pediatric ostomies, the continent ileostomy, urostomy, laparoscopic stoma construction, stomas in trauma surgery, stomas for antegrade continence enema, percutaneous ostomies, and quality of life. There are also sections on ileostomy, colostomy, enterostomal therapy and on the management of complications of stomas such as management of the high output ostomy, enterocutaneous fistula, parastomal hernia, prolapse, and skin conditions. The Cleveland Clinic pioneered the entire practice of ostomies, beginning in 1858 and continuing to this day as the world's leading academic and clinical center. The editors and contributors are all current or former Cleveland Clinic physicians and instructors. The fundamental focus of the book is not only how to install ostomies, but how to avoid complications and how to treat complications when they arise. Atlas of Intestinal Stomas will be of great value to colorectal and general surgeons, both in practice and in training.

Vascular care has evolved from conservative therapy and open surgical therapy to a minimally invasive approach using endovascular techniques, laparoscopic or thoracoscopic techniques as well as hybrids of open and endovascular techniques. This volume provides up-to-the-minute information and details new developments and procedures.

The complexity of decision making in thoracic surgery is growing exponentially. As new technology is introduced, physicians from nonsurgical specialties offer alternative and competing therapies for what was once the exclusive province of the thoracic surgeon. In addition, there is increasing knowledge regarding the efficacy of traditional thoracic surgical therapies. How to select among these varied and complex approaches is becoming increasingly difficult. The first two editions of this book have found wide acceptance among practicing surgeons, trainees, and educators. Chapters from them are regularly cited by the Thoracic Surgery Directors Association as valuable resources for their weekly curriculum exercises. As in the first two editions, chapters adhere to a specific format (updated for the third edition). This approach provides uniformity to the presentations, making it possible to identify useful material at a glance.

Now in its 4th edition, Kirklin/Barratt-Boyes Cardiac Surgery remains your indispensable source for definitive, state-of-the-art answers on every aspect of adult and pediatric cardiac surgery. This dynamic medical reference thoroughly and systematically covers the full range of new and classic surgical procedures-including the latest alternate and minimally invasive surgical techniques-and presents the up-to-date clinical evidence you need to make effective management decisions. Be certain with expert, dependable, accurate answers for every stage of your career from the most comprehensive, definitive text in the field! Get comprehensive coverage of all areas of cardiac surgery, including ischemic, valvular, and congenital heart disease; cardiac tumors; constrictive pericarditis; thoracic aortic surgery; cardiac transplantation; coronary artery disease; aortic valve disease; cardiac rhythm disturbances; heart failure and transplantation; disease of the thoracic aorta; tetralogy of Fallot; anesthesia; and postoperative care. Stay current with the latest advancements and practices. Comprehensive updates throughout include new information on endovascular management of thoracic aorta disease; new data on clinical outcomes; the most recent minimally invasive procedures; non-invasive CT angiography; new alternative surgical approaches to mitral valve surgery; and many other hot topics! Make the most well-informed decisions and achieve optimal outcomes by exploring each condition's natural history; diagnostic criteria; indications for surgery; operative techniques; and follow-up care. Reference information quickly thanks to a new, streamlined format and easily searchable online access to the complete text, downloadable image library, reference links, and more at expertconsult.com. Visually grasp and better understand critical information with the aid of a new, full-color design that includes an abundance of detailed charts and graphs. Stay current with the latest advancements and practices. Comprehensive updates throughout include new information on endovascular management of thoracic aorta disease; new data on clinical outcomes; the most recent minimally invasive procedures; non-invasive CT angiography; new alternative surgical approaches to mitral valve surgery; and many other hot topics! Reference information quickly thanks to a new, streamlined format and easily searchable online access to the complete text, downloadable image library, reference links, and more at www.expertconsult.com. Master cardiac surgery with the Gold Standard for Cardiac Surgery - the most definitive and clinically comprehensive resource on cardiologic procedures including latest alternate and minimally invasive surgical procedures

Preoperative and intraoperative echocardiography has become an indispensable tool for guiding mitral valve surgery and has fostered the development of many innovative surgical techniques. Mitral valvuloplasty is now an established surgical method for the treatment of mitral insufficiency but the success is largely dependent on the extent of the underlying disease of the mitral valve. The book by Dr. Ng and coauthors is an extraordinary presentation of the relation between echocardiographic display of mitral valve pathology and reconstructive mitral valve surgery. The atlas provides an excellent illustrative guide to teach echocardiographic-anatomic correlations and educates the reader on the techniques of mitral valve repair. The quality of the illustrations, particularly the surgical photographs is exquisite. The book will be helpful for cardiologists and cardiac surgeons.

Operative Anatomy of the Heart offers a unique collection of data and artwork, illustrating cardiovascular surgery and surgical procedures. The coverage is exhaustive, extending to the entire anatomy of the human chest. An appendix presents cross sections of the human body: thoracic, abdominal and pelvic cavity. These are presented as morphological guidelines for better interpretation of the computer scans. This is a book of unique visual and functional utility.

"Potential anatomical spaces" have attracted surgeons in the past and in recent years. Due to the development of modern imaging techniques and the advent of minimally invasive surgery, access to these spaces has become a real surgical option. The purpose of this book is to document the challenges related to "potential anatomical spaces", traditionally described as "hidden" spaces. The spread of video-assisted surgery and its application in the management of diseases involving organs or anatomical structures placed in the "potential spaces" (neck, mediastinum, pro-peritoneum and retro-peritoneum, subfacial space of the leg, and axilla), has rendered their surgical anatomy less abstract.

It is with great pleasure that we here present Artificial Heart 4 (proceedings of the 4th international symposium on artificial heart and assist devices). The symposium was held in Tokyo, Japan, on August 7 and 8, 1992 under the patronage of Mr. Hiromitsu Yoshioka, Chairman of the Board of Trustees, Tokyo Women's Medical College. Artificial heart 4 consists of the papers presented in nine sessions: Oral Presentations A to E, Forums 1 to 10, and nine lectures by invited guest speakers from the United States and Europe. In this volume, papers from two new sessions, sessions IV and VII, entitled New Approaches, were prepared for devices and systems developed according to new ideas. Twenty-one papers in these two sessions were presented in five Forums (3, 4, 7, 8, and 9). Session VI was provided to deal with heart transplantation, which is now closely related to both ventricular assist systems (VAS) and the total artificial heart (TAH). In this session, papers by two guest speakers from major heart transplantation centers in Europe were included.

The 5th International Symposium on Artificial Heart and Assist Devices was held in Tokyo on January 26 - 27, 1995, bringing together leading researchers and specialists from all over the world. The proceedings of the symposium presents the newest ideas and approaches in the field, and will be of special interest and relevance to all who are concerned with artificial organs, cardiovascular surgery, organ transplantation, biomaterials, and related disciplines. Reflecting the content of the symposium, the major topics in this volume include biocompatible material development, clinical use of assist devices, completely implantable devices, and heart transplantation. These are presented in the two main divisions of the book: The first consists of eight lectures by leading researchers, world-renowned in the field of the artificial heart. The second comprises more than 50 papers on such subjects as biomaterials, research and development of ventricular assist systems and the total artificial heart, and their use as a bridge to heart transplantation. An additional, special feature of the book is the inclusion of descriptions of exhibitions at the symposium, with photographs of all artificial heart devices and systems displayed by major laboratories and companies from around the world.

Transmediastinal gunshot injuries present the risk of immediately life threatening injuries. Stable patients have been evaluated by a combination of esophageal swallow and endoscopy, aortography and bronchoscopy. There is an increasing trend favoring CT scan. Unstable patients require immediate exploration, being prepared to enter both hemi-thoraces. Selected References: * Bergsland J, Karamanoukian HL, Soltoski PR, Salerno TA. Single suture forcircumflex exposure in coronary artery bypass grafting. Ann Thorac Surg.1999;68: 1428-1430. * Fedalen PA, Bard MR, Piacentino V, et al. Intraluminal shunt placement and off- pump coronary revascularization for coronary artery stab wound. J Trauma 200 1;50: 133-135 * Hanpeter DE, Demetriades D, Asensio JA, Berne TV, Velmahos G, Murraygunshot wounds. J Trauma 2000;49(4):689-695. * MacPherson D. Bullet Penetration: Modeling the dynamics and the incapacitation resulting from wound trauma. Ballistics Publications, EI Segundo, CA, 1994 * Wall MJ, Soltero E. Damage control for thoracic injuries, Surg Clin North AmI997;77(4):863-878. * Rozycki GS, Feliciano DV, Oschner MG, Knudson MM, Hoyt DB, Davis F, Hammerman D, Figueredo V, Harviel JD, Han DC, Schmidt JA. The role ofUltrasound in patients with possible penetrating cardiac wounds: aProspective multicenter study. J Trauma 1999; 46(4):543-552. * Roussseau H, Soula P, Bui B, D'Othee BJ, Massabuau P, Meites G, Concina P,Mazzerolles M, Joffre F, Otal P. Delayed treatment of traumatic ruptureof the thoracic aorta with endoluminal covered stent. Circulation 1999 Feb2; 99(4): 498-504.

CARDIAC VALVE ALLOGRAFTS (HOMOGRAFTS) highlights the current controversy about "freehand subcoronary aortic valve and root" "replacement" with regard to postoperative morbidity and long term durability. It discusses particular implantation techniques of preference in young patients and in different root pathology. Other chapters address intermediate- and long-term results on cardiac valve and vascular homografts for treating complicating cardiac valve and aortic infections.
The chapter on basic science additionally makes this book a highly authoritative reference source for cardiac surgeons, physicians and scientists.
This work provides a current survey of the state-of-the-art.

Rotary blood pumps increasingly are being used in open heart surgery and in assisted circulation for patients with heart disease. These rotary devices include vortex (centrifugal) and axial pumps, which can be utilized in conditions where the use of conventional pulsatile pumps would entail problems of cost and size. Rapid progress is now being made in developing new devices for controlling blood flow within the heart and great vessels as well as extracorporeally for use in coronary and intensive care units and, in the future, for long-term use. This book provides information on the physiology of nonpulsatile circulation, the development of rotary pump engineering, and the clinical application of rotary blood pumps. It also presents an overview of future developments in this important field.

This monograph highlights modern concepts of brain ischemia and strategies of neuroprotective therapy. The first part of the book is devoted to mechanisms of ischemic brain damage. The authors present the results of their own clinical and experimental studies conducted in the last two decades, as well as the achievements of native and foreign neurological researches that open a new stage in understanding how reversible changes of blood flow and metabolism are transformed into a permanent morphological lesion, i.e. brain infarction. The most important advances in areas of ischemic energy failure, main mechanisms of the glutamate-calcium cascade, influence of metabolic acidosis on ischemic damage, delayed neuronal death connected with microglial activation, local inflammation, autoimmune reactions, trophic dysfunction, and apoptosis, as well as of reaction of the stress-mediating endocrine system to focal brain ischemia are shown in animals and humans, and the relevant literature is cited and critiqued.The book also explores topics that recently have experienced substantial growth, such as gene expression and subsequent molecular events in response to acute brain ischemia, connected with both tissue damage and reparation. The authors demonstrate not only universal features of the process of brain ischemia, but also individual peculiarities of its course in patients and analyse their reasons.

Following many years when a great deal of attention was directed towards the intracellular roles of purines, there is expanding interest in the field of extracellular purinergic signalling. In this book we focus on the actions of purines in cardiovascular biology, where it is clear that they play major roles in both normal and pathophysiological conditions. Activation of different purinoceptor subtypes by purines can regulate cardiac contractility and electrical activity, modulate catecholamine-mediated responses both pre- and post-junctionally, trigger and mediate ischaemic preconditioning, cause vasodilation and vasoconstriction and enhance endothelial proliferation and apoptosis as well as inhibit platelet and neutrophil function. This book covers the cardiovascular actions mediated by the major P1 and P2 subclasses of purinoceptors and emphasizes the interactions between these two signalling systems. Cardiovascular Biology of Purines covers topics ranging from molecular and cellular to systemic and clinical. It also aims to highlight how basic advances have led to the identification of novel targets for cardiovascular therapeutic developments. We hope that our book will prove to be timely and helpful.

Interventional cardiology is a creative, innovative, and rapidly advancing frontier of cardiology. There has been mind-boggling proliferation of tech nology in this field, the use of which requires extraordinary skills and know how. In order to keep pace with the innovative genius of interventional cardiologists, it is indeed desirable to have specialty issues updating us on technology-orientated therapeutic procedures. Contemporary interventional cardiology care is a highly specialized art, dependent on critical decision making, selection of the most appropriate inter ventional procedure, and the operator possessing extraordinary skills and compassion. This first volume of the new series, Supported Complex and High Risk Cor onary Angioplasty, attests to the preceding statement. Dr. Fayaz Shawl has mastered the procedure and has been very thoughtful and innovative in the clinical application of the percutaneous cardiopulmonary bypass support tech nique. This book provides to an interventionist the basic principles of car diopulmonary bypass, identification of the high risk coronary angioplasty patient, and other alternate support devices for myocardial protection. Dr. Shawl and his team of talented contributors are to be complimented for providing us with this impressive volume on high technology. There will be ongoing specialty issues in this series highlighting the devel opments, complications, and advances in interventional cardiology.

Heat shock proteins (HSP) were originally described in heat-shocked drosophila by Ritossa in the early 1960's. In the last 5 years it has become apparent that these heat shock proteins have important functions both in the normal cell and in the stressed cell. These proteins constitute an endogenous protective system; mutations in the heat shock proteins can be lethal, and there are no known organisms without heat shock proteins. The first observations on heat shock proteins and the heart were made in the 1980's and interest in these proteins increased over the decade. In the last few years there has been an exponential growth in number of papers published on heat shock proteins and the heart. Heat shock proteins have been implicated in a number of cardiovascular research areas including ischemia, hypertrophy, aging, and atherosclerosis, and this list is growmg. The purpose of this volume is to give an overview of our current understanding of the heat shock proteins in the cardiovascular system, and to summarize the approaches to the study of heat shock proteins in the heart. This volume assembles results from a number of different cardiovascular fields. and provides a comprehensive review of heat shock proteins in the cardiovascular system.

Despite approximately 50 years of progress in the management of com plex congenital heart disease, hypoplastic left heart syndrome (HLHS) has been one of the last cardiac malformations to yield to effective surgical treat ment. The surgical therapies for hypoplastic left heart syndrome have evolved by two quite disparate routes. One approach has been the staged reconstruc tion operations utilizing an initial operation pioneered by many but developed by Dr. William Norwood and subsequently modified by many other investigators. The first stage reconstruction operation has been refined and standardized such that the majority of infants now proceed to second and third stage reconstruc tive operations culminating in a Pontan Kreutzer single ventricle physiology. An alternative surgical approach has been the development of neonatal and infant heart transplantation for HLHS. This approach also has had a signifi cant impact on the treatment of HLHS and other cardiac malformations and has been associated with good intermediate term results. Both of the thera peutic approaches devised for treatment of hypoplastic left heart syndrome have been effective and the outcomes are continuing to improve with each.

Heart transplantation remains one of the major scientific achievements of twentieth century medicine. During the past four decades, it has evolved from an unproven experimental surgical technique to the most effective form of therapy for refractory end-stage heart disease. It has captured the public's imagination and expanded our understanding of fundamental immunologic mechanisms that are responsible for cellular and humorally-mediated immunity. Despite its successes, many clinical and scientific problems remain. One or more bouts of acute cellular or humoral (vascular) rejection will occur in over 75% of transplant recipients despite current immunosuppressive strategies. Further, rejection directly results in approximately 20% of post-transplant deaths and is believed to play a major role in the development of late allograft dysfunction and coronary vasculopathy. This book by international experts in the fields of transplantation medicine, immunobiology and cardiac imaging provides the reader with an up-to-date, consise summary of the latest developments in the diagnosis and treatment of acute cardiac rejection. It is axiomatic that a more complete understanding of the pathogenic processes involved in rejection will ultimately lead to its prevention. This volume will be useful to transplant cardiologists, cardiovascular surgeons, cardiac pathologists and transplant scientists who seek to prolong the lifespan and improve the quality of life of their transplant recipients.

As societies have aged and aortic diseases have become more prevalent, advances in diagnostic imaging and surgical techniques have brought significantly improved results for patients. In cardiovascular surgery, important questions remain to be addressed, however. "Strategy for Cardio-aortic and Aortic Surgery" was the theme of the 7th Keio University International Symposium for Life Sciences and Medicine. Meeting in Tokyo, researchers and specialists in cardiac surgery from around the world discussed crucial issues in their field. Papers from the symposium, collected in this volume, cover a broad range of topics, including recent advances in diagnostic imaging, brain protection during aortic surgery, spinal protection during thoracoabdominal aneurysm repair, treatment of type A acute aortic dissection, and stent-grafts and less-invasive aortic surgery. This unique book provides valuable information especially for aortic, cardiovascular, and thoracic surgeons.

Cardiac Valve Replacement: Current Status is the proceedings of the Fourth Interna tional Symposium on the ST. JUDE MEDICAL@ valve. The first three symposia on this topic were held primarily for designated investigators involved in clinical trials of the ST. JUDE MEDICAL valve. The last meeting, chaired by Michael E. DeBakey, M.D., was held in November 1982 [1], immediately before the valve was released for general clinical use in the United States by the Food and Drug Administration. These proceedings then are the first comprehensive compilation of clinical data since that time; and they include, particularly in the discussions, the experience of physicians other than the original clinical investigators. Over the past 5 years the character of these symposia has changed. Whereas the first two dealt almost entirely with the ST. JUDE MEDICAL valve, the last two have evolved into a more generic cardiac valvular surgery meeting, focusing primarily on valve replacement rather than valve repair [2]. Thus, these proceed ings contain a wide spectrum of topics, including a keynote presentation on criteria for selection of cardiac valve substitutes in 1984, complications of cardiac valve replacement and their treatment, a review of the current status of cardiac valve substitutes other than the ST. JUDE MEDICAL valve and a consideration of cardiac valve replacement in special circumstances. Among these special circum stances are four presentations on pediatric use of the ST. JUDE MEDICAL valve.

viewed as rolling downhili from an uphill or This book represents an edited compilation of the scientific presentations given at an Interna- high-energy state. This transition results from tional Symposium on the Physiology of Diastole the opening of membrane pores that allow in Health and Disease, September 11 to 14, calcium to rush into the cytosol, triggering 1986, in Cambridge, Massachusetts. Numerous excitation-contraction coupling. If the energy studies have documented the importance of available to sarcoplasmic reticular and sarcolem- diastolic dysfunction in clinical heart disease. In mal calcium pumps was insufficient to remove recent years clinicians have become increasingly this calcium from the cytosol and res tore the aware that many patients with congestive heart 1O,OOO-fold calcium gradient, characteristic of failure have completely normal myocardial con- the "resting" myocyte, we would live for one tractile function. In these patients, inotropic glorious systole and die in cardiac rigor. The agents provide no clinical benefit and may in well-known phenomenon of rigor mortis re- fact exacerbate clinical manifestations of heart minds us that for skeletal muscles as weIl relaxation is the high-energy state and per- failure. These patients, who may be regarded as having diastolic heart failure, represent a major manent contraction is the inevitable downhili therapeutic challenge today. It has also become state for muscle that can no longer produce increasingly apparent that a variety of patho- adenosine triphosphate.