This book provides an in depth review of the current practice in treating elderly patients with coronary artery disease (CAD) as well as an update of the existing literature. It is intended to reflect the current science of elderly patients with stable angina, acute coronary syndromes and those patients who are forwarded for CAGB procedures. Evidence in the elderly patient group is often limited and/or non-existent therefore the main challenge, even for further research, will be to define the role of geriatric preconditions and its impact on outcome. A second topic will be to clarify how, if ever, existing cardiological outcome values like mortality can be applied to elderly patients or if other values like improvement of functional status or quality of life are more suitable parameters to measure interventional success in elderly patients. The role of pharmacotherapy in advanced age has to be discussed. These topics will be embedded in epidemiological, pathophysiological and ethical aspects of interventional treatment of CAD in older age.

Extracorporeal membrane oxygenation (ECMO) has been in clinical use for some 40 years, but it is only in the past decade that its application in the treatment of life-threatening circulatory and respiratory failure has truly flourished. This book presents a comprehensive overview of both pathophysiological and practical aspects of circulatory and respiratory extracorporeal support. The basics of ECMO, including its history, the "ECMO team", cannulation, materials, and blood-surface interactions, are first discussed. The various indications for and particular characteristics of circulatory and respiratory extracorporeal life support are then described in detail in the main part of the book. Patient care during ECMO and monitoring of the ECMO patient are also carefully covered, with explanation of the management of technical and clinical complications and transport-related problems. Further topics include long-term therapy options beyond ECMO, such as ventricular assist devices and transplants, outcome, the new frontiers of ECMO for organ procurement and future challenges. The authors are well-known experts in the field whose authoritative contributions and attention to practical aspects will be invaluable for novices and experienced practitioners alike.

Percutaneous left atrial appendage (LAA) closure is an emerging technology for thromboembolic prevention in patients with atrial fibrillation (AF). The first human implantation of an LAA device occurred in 2001, and since then four devices have received CE mark approval. These devices are being widely used in Europe for LAA closure in patients who are poor candidates for long-term oral anticoagulation. In the US, the WATCHMAN device (Boston Scientific) is anticipated to receive FDA approval imminently for AF patients who are warfarin-eligible. This approval is projected to significantly expand the indications for LAA closures worldwide. Thus, the volume of procedures is anticipated to escalate. This book discusses the epidemiology of AF as a cause of stroke; the use of LAA closure in the reduction of thromboembolism with AF; early surgical approaches and novel surgical devices for LAA closure; and current percutaneous approaches and devices available for LAA closure. The emphasis of this book is on percutaneous technical approaches and contemporary trial results on the leading devices (PLAATO, WATCHMAN, Amplatzer Cardiac Plug, and LARIAT). It also reviews unapproved devices in development, in both clinical and pre-clinical phases.

Heart disease in children has a number of diagnostic traps for the unwary, and all of us involved in the specialty have been caught at one time or another. For example, it is sometimes very difficult to differentiate between respiratory and cardiac disease in infants and between neurological and cardiac conditions in older children, and the consequences of taking the wrong path can be significant. This book is a collection of cases highlighting situations which can ensnare even the best cardiologist. Although they illustrate the importance of taking a good history and performing a thorough examination, the most important lesson is learning to keep an open mind and develop the ability to think laterally. As clinicians we need to have the confidence to make a decision for our patients but also the humility to be able to acknowledge that we don't always get it right first time, and it is imperative that we learn from the experience. We hope the reader will find these short chapters interesting and while they are not evidence-based medicine in the true sense, they do represent a wide range of clinical experience from which we can all learn.

Since the introduction of laser devices to the medical sciences this technology has created great interest. Specifically, the laser's unique physical properties and precise bio-tissue interactions render this versatile source of biologic energy an attractive tool for multiple therapeutic purposes in cardiovascular medicine. Over the course of the last 2 decades the utilization of laser technology has become an important component for the management of patients with complex cardiovascular diseases. During this time period, cutting edge laser technology including a variety of wave length generators, newly designed catheters, and a selection of advanced optic fibers have been introduced and applied in the cardiovascular circulation. Improved lasing techniques in the cardiac catheterization suites and operation rooms have been implemented for treatment of ischemic coronary syndromes, peripheral arterial occlusive disease and other atherosclerotic thrombotic conditions. Moreover, during this 20 year time frame, several multicenter and single center clinical studies have been published focusing on the role and utilization of lasers in coronary and peripheral revascularization. And within the rapidly expanding field of interventional cardiac electrophysiology, laser technology has recently revolutionized the management of fractured, abandoned and malfunctioning leads of cardiac pacemakers and automatic defibrillators. Consequently, replacing a notoriously cumbersome and high risk open heart surgery with safe and markedly efficient percutaneous laser based extraction. This textbook will provide the most authoritative, comprehensive and contemporary information covering technological progress, clinical experience and pertinent aspects of laser applications in cardiovascular medicine. It will be of interest to cardiologists, vascular surgeons and interventional radiologist as well as medical students, scientists, biomedical engineering students and graduates.

This book provides information on the acquired and genetic basis of aortic diseases as well as giving a global perspective on therapeutic alternatives. The new concept of a team approach with surgeons working together with both interventional radiologists and specialists to repair the aorta is the trademark of this book. New material and new viewpoints are provided to practicing physicians in this modern approach to the treatment of disorders of the aorta.

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.

"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.

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.

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.

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.

This book sets out to illustrate the key steps in some of the commoner procedures in pulmonary and oesophageal surgery. Each chapter deals with one operation. It was always our intention that the emphasis should be on detailed illustrations of the various stages of each operation. The text is of secondary importance, serving to provide continuity and to guide the reader through the illustrations. The techniques outlined are those which have evolved in our practice over the years and are therefore the result of varied influences and personal experience. Where an individual surgeon's name is attached to an operative technique we make no claim to describe the procedure exactly as that surgeon would have performed it, and it would perhaps have been more accurate to describe the technique as being "in the style of ...... ". We would wish to apologise in advance to any surgeon who feels that we have not accurately depicted his technique or have deviated from it in any important respect.

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.

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.

Venous valves rank among the smallest and most delicate organs of the human and animal bodies - so why devote an entire book to them? We were induced to do so by several reasons. First of all we would point out the clinical significance of venous valves. In the pathogenesis of a number of widespread diseases, such as varicose veins or the post-thrombotic syndrome, venous valves are involved as the underlying cause or at least a factor contributory to the symptoms. According to Taheri et al. these venous diseases occur ten times more frequently than arterial obliterations. Incompetence of venous valves also plays a causal role in varicocele, the most frequent cause of male infertility. But not only pathogenetic reasons induced us to write this book. In more recent times there has been a growing tendency to reconstruct functional valve disorders therapeutically; several surgical methods have been developed, which are critically reviewed in this book. It was our aim to sum up existing knowledge with respect to structure and function of venous valves and to expand that knowl edge by findings of our own. Examinations of semi-thin sections and unilayered en-face preparations have hardly been published so far, and systematic studies of the ultrastructure by electron-microscopy were not to be found in the literature. We are very grateful, therefore, to Dr. Silvana Geleff for having undertaken such a study upon our suggestion."

Our understanding of the pathophysiology of acute myocardial infarction has grown enormously in recent years. This has led to an increasingly aggressive approach to management, designed to blunt the extent of infarction by salvaging acutely ischemic myocardium. Alternatives now include throm bolysis, PTCA with and without prior thrombolysis, and emergency bypass surgery, as well as the more aggressive use of a variety of drugs. This book consists of a series of chapters by experienced cardiologists and cardiovascular surgeons that present today's state of the art in managing acute myocardial infarction. It is written with the purpose of presenting practical approaches of value to the clinician related to the more complex problems faced in dealing with patients undergoing myocardial infarction. xi EARLY INTERVENTIONS IN ACUTE MYOCARDIAL INFARCTION 1. MANAGEMENT OF ARRHYTHMIAS IN THE CORONARY CARE UNIT NORA GOLDSCHLAGER, RODERICK WOODS, AND NEAL BENOWITZ With the advent of coronary care units, mortality from cardiac arrhythmias occurring during acute myocardial infarction has been unquestionably and dramatically reduced. In addition, continuous electrocardiographic monitoring has resulted in the recognition of specific arrhythmias related to acute ischemic heart disease and thus to the development of appropriate strategies for their management. This chapter will review certain specific aspects of those bradyarrhythmias and atrial and ventricular tachyarrhythmias that are seen most commonly in acute myocardial infarction. Pharmacologic therapy, including the use of some of the newer antiarrhythmic agents, will be discussed, as will pacemaker ther apy of both bradyarrhythmias and tachyarrhythmias."

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.

Restenosis, the proliferation of smooth muscle cells (SMC) that line blood vessels, often follows angioplasty. Despite advances in cardiology, restenosis continues to affect up to 40% of the over 500,000 patients who undergo angioplasty each year. Applications of Antisense Therapies to Restenosis is the first volume to address the potential of using antisense therapies to inhibit the restenosis that occurs after percutaneous transluminal angioplasty and coronary stenting. The work critically examines the application of various antisense therapies for inhibiting restenosis.

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.

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.

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.