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.

Since the first pacemaker implantation in October 1958 by Senning and Elmqvist in Sweden, cardiac pacing for bradycardia has become a well-established therapy. The impressive growth of clinical experience and the rapid development of pacemaker devices have greatly contributed to this situation. The electrical therapy appears to be so easy that insertion of the lead and its connection to the pacemaker generator requires little effort, skill or insight. However, after implantation a patient's condition seldom remains stable, which requires a flexible pacing program to cover all new cardiac events, and broad insight from clinician and technical colleagues. The Pacemaker Clinic of the 90's teaches anatomical and electrophysiological aspects of pacing, supports the prevention of complications, and points to new developments in the field. Apart from classical indications for cardiac pacing, the book discusses the validity of the latest indications, supporting the cardiologist and the associated professional in selecting the appropriate pacing mode and pacemaker follow-up in individual patients. The Pacemaker Clinic of the 90's will be a helpful companion for years to come.

The topics in this book represent the presentations given at the Seventh Annual Meeting entitled "Cardiac Surgery: Current Issues," held at the Frenchman's Reef Beach Resort, St. Thomas, U.S. Virgin Islands, November 9-12, 1994. This symposium was sponsored by the American College of Chest Physicians in conjunction with the Division of Cardiothoracic Surgery of Cooper HospitallUniversity Medical Center, the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Camden, New Jersey. Chapter authors were charged with the task of writing brief overviews of major issues related to the field of cardiac surgery. The book is specifically tailored to the needs of cardiothoracic surgeons, cardiovascular perfusionists, allied health professionals, and nurs ing personnel involved in all phases of caring for the cardiac surgical patient. Although intended as a reference source with emphasis on updated approaches applied in cardiac surgery, it is hoped that the discussion of these topics will compliment other texts and manuscripts. Obviously, a book of this length cannot cover the whole multidisciplinary and complex field of cardiac surgery. However, co-editors are certain that the annual appearance of this text will highlight comprehensive, new, and interesting approaches to the field of cardiac surgery. The co-editors are greatly thankful to the contributors for their efforts in providing comprehensive chapters. Without their expertise, this work may not have been possible. We would also like to thank Ms. Eileen Birmingham and the staff at Plenum Publishing Corporation for their tremendous help in completing this work.

Cardiovascular disease is the major cause of morbidity and mortality worldwide. While the past 40 years have brought major progress in cardiac valve repair and replacement, there remain large patient populations that do not receive such therapies. This, in turn, implies a great need for future basic, applied, and clinical research and, ultimately, therapeutic developments. Heart Valves is a state-of-the-art handbook dedicated to: 1) cardiac valve anatomy, 2) models for testing and research methods; 3) clinical trials; and 4) clinical needs and applications.

This thesis addresses computation fluid dynamics modelling of aortic dissection (AD), in order to generate in silico diagnostic information and assess 'virtual surgery' outcomes. The thesis introduces several important advances in the modelling of aortic dissection and lays essential groundwork for further development of this technology. The work thesis represents a unique and major step forward in our understanding of AD using a patient-specific, systematic and coherent simulation approach, and is currently the most advanced work available on AD.

Cryopreserved allograft tissues are now standard materials for the reconstructive cardiac surgeon. Since publication of the first edition ("Cardiac Reconstructions with Allograft Valves") in 1989, the field has progressed dramatically with increased clinical use of cardiovascular allograft tissues, with the development of new surgical techniques, and with advances in the understanding of the fundamentals of valve transplantation biology and cryopreservation. As a result, over two-thirds of the present volume represents new material. Fifty-six authors bring their expertise to thirteen comprehensive, lavishly illustrated sections which discuss the principles of the use of homograft valves, major clinical series of homograft valves for both left and right ventricular outflow tracts, cryopreserved allograft tissue for cardiac reconstruction, cell biology of heart valve leaflets, cryobiology of heart valve preservation, morphological, biochemical, and explant pathology studies of allograft heart valves, allograft valve banking, as well as detailed explanation of surgical techniques for valve and root methods for left and right ventricular outflow tract reconstructions, the Ross operation and variants, and complex reconstructions. A final section presents potential future directions for the field. Over 400 illustrations, created expressly for this book, depict the surgical techniques from the perspective of the surgeon standing at the operating table. All surgeons performing pediatric and/or adult valve replacements and reconstructive cardiac surgeries will benefit from the described methods. Cardiothoracic residents and cardiologists will also find the text useful. It will provide the surgeon with an enhanced understanding of the biological and material properties of allografts and increased familiarity with the range of surgical techniques applicable for the use of these valves, particularly in the successful management of challenging cardiac reconstructions.>

Preface. Part One: Pathophysiology of ischemia and reperfusion. 1. Moderate ischemic injury and myocardial stunning; M.E. Zughaib, P.B. McCay, M.O. Jeroudi, C. Hartley, Jian-Zhong Sun, S. Seikili, Xiao-Ying Li, R. Bolli. 2. Severe ischemic injury and the oxygen paradox; H.M. Piper, B. Siegmund, K.-D. Schluter. 3. Role of leukocytes in reperfusion injury; S.L. Hale, R.A. Kloner. 4. Ischemia of the neonatal heart; F.M. Lupinetti. Part Two: Concepts of cardioplegia. 5. Cardioplegia with an intracellular formulation; C.J. Preusse. 6. Cardioplegia with an extracellular formulation; D.J. Chambers, M.V. Braimbridge. 7. Blood cardioplegic strategies during adult cardiac operations; G.D. Buckberg, B.S. Allen, F. Beyersdorf. Part Three: Clinical application of cardioplegia. 8. High volume perfusion; I.B. Krukenkamp, C.A. Caldarone, P. Burns, S. Levitsky. 9. Intermittent coronary perfusion; H.D. Schulte. 10. Retrograde perfusion; P. Menasche. 11. Cardiac arrest by ventricular fibrillation; C.W. Akins. 12. Myocardial preservation in the immature heart; J.E. Mayer, Jr. Part Four: Evaluation of cardioplegic methodology. 13. High-energy phosphates and their catabolites; J.W. de Jong, T. Huizer, M. Janssen, R. Krams, M. Tavenier, P.D. Verdouw. 14. Lactate monitoring during and after cardiopulmonary bypass: an approach implicating a perioperative measure for cardiac energy metabolism; E.-G. Krause, D. Pfeiffer, U. Wollenberger, H.-G. Wollert. 15. Myocardialtissue pH in the assessment of the extent of myocardial ischemia and the adequacy of myocardial protection; M.B. Tantillo, S.F. Khuri. 16. Morphology of the acute and chronic ischemic myocardium in man; M. Borgers, W. Flameng. 17. Muscle birefringence; S. Darracott-Cankovic. 18. How to measure cardiac energy expenditure; M.Takaki, T. Namba, J. Araki, K. Ishioka, H. Ito, T. Akashi, Ling Yun Zhao, Dan Dan Zhao, Miao Liu, W. Fujii, M. Takaki, H. Suga. 19. Cardioplegia and cardiac function; D. Baumgart, R. Schulz, T. Ehring, G. Heusch. Index.

Bronchiolitis Obliterans Syndrome in Lung Transplantation presents the most current and up-to-date evidence regarding the diagnosis and management of BOS. In-depth chapters provide readers with a comprehensive understanding of the definition and changing perceptions of the nature of BOS as a clinical and pathologic entity, immune and non-immune mechanisms that have been identified as risk factors for the development of BOS, and interventions that may prove to be clinically useful for the prevention or treatment of BOS. In addition to outlining the current state of knowledge, each chapter provides the reader with the most current and ongoing research in the field as well as identifies areas where future research is needed. Written by an international group of expert authors, Bronchiolitis Obliterans Syndrome in Lung Transplantation is an important new text, that is essential reading for pulmonologists, primary care practitioners, respiratory care practitioners and clinical researchers.

This book provides an overview of the etiology of coronary artery disease and focuses on the main therapies and drug interventions currently available. It highlights drug pharmacology and therapeutic challenges, with a special emphasis on the underlying principles of available therapeutics and the on-going development of drugs for coronary artery disease. The book is divided into eight chapters, the first of which describes the classical mechanism of coronary artery disease and its clinical presentations. Chapter 2 lists the principles of and related evidence on the prevention and treatment of coronary artery disease. This includes diet and lifestyle management, and guidelines for the treatment of acute coronary syndrome and stable coronary artery disease. In turn, Chapter 3 describes revascularization treatments, covering percutaneous coronary interventions, coronary artery bypass grafts and thrombolysis. This chapter also addresses the main therapeutic challenges. The following chapters provide an overview of three major categories of coronary artery disease drugs, which target thrombosis (Chapter 4), lipid metabolism (Chapter 5), and hypertension (Chapter 6). Heart failure constitutes the major health burden in the late stage of coronary artery disease; accordingly, current heart failure therapeutics and related drug pharmacology are described in Chapter 7. In closing, Chapter 8 provides a summary of on-going clinical trials for coronary artery disease drug development and discusses a number of promising areas in which intensive research into new therapeutics is being pursued. Given its scope, the book will be of interest to clinicians, medical students and research scientists, as well as to pharmaceutical professionals who are seeking new therapies and drugs for coronary artery disease and related disorders.

This book on cardiac extracellular matrix (ECM) features three sections, Fundamental Science, Pre-Clinical and Translational Science, and Clinical Applications. In the Fundamental Science section, we will cover the spectrum of basic ECM science from ECM's role in development, biomechanical properties, cardiac ECM influence of cardiomyocyte biology, pathophysiology of ECM in heart disease, and ECM in tissue engineering. Section two, Preclinical and Translational Science, will discuss cardiac ECM technologies in the clinical pipeline including approaches to ECM as a therapeutic, animal models of cardiac research, tracking and imaging methods of cardiac ECM, and cGMP manufacturing and regulatory considerations for ECM based therapeutics. Finally, the third section, Clinical Applications, will highlight the clinical experience around cardiac ECM including therapeutic strategies targeting scar tissue in the heart, Clinical trial design and regulatory considerations, current human clinical trials in cardiovascular medicine and the role of pharmaceutical and biotech companies in the commercialization of ECM technologies for cardiovascular indications. This book provides a comprehensive review for basic and translational researchers as well as clinical practitioners and those involved in commercialization, regulatory and entrepreneurial activities.

This issue of Thoracic Surgery Clinics, guest edited by Dr. Bryan M. Burt, is devoted to Malignant Pleural Mesothelioma. Dr. Burt has assembled expert authors to review the following topics: Biomarkers for the Diagnosis and Monitoring of Malignant Pleural Mesothelioma; Taken Together: Effective Multimodal Approaches for Malignant Pleural Mesothelioma; Pleurectomy/Decortication for Malignant Pleural Mesothelioma; Preoperative Identification of Benefit from Surgery for Malignant Pleural Mesothelioma; The Role of Extrapleural Pneumonectomy in Malignant Pleural Mesothelioma; The Molecular Basis of Malignant Pleural Mesothelioma; Radiation Therapy for Malignant Pleural Mesothelioma; The Staging of Malignant Pleural Mesothelioma; Intraoperative Adjuncts for Malignant Pleural Mesothelioma: The Fourth Dimension; The Pathology of Malignant Pleural Mesothelioma; and more!

The motivation for this book was the recognition by two of us (RL and TL) that, despite our training as cardiologists, we had a limited understand ing of many aspects of the surgical management of our patients. Conversa tions with other cardiologists at our own institution and at other medical centers around the country convinced us that many of our colleagues shared our uncertainty about the details of surgical procedures and the factors that determine decisions in the perioperative period. As surgical techniques continue to evolve, this knowledge gap can become only more severe. We therefore compiled information about cardiac surgery that might be useful for cardiologists and other nonsurgeons. We asked cardiologists what questions they would like to ask their surgical colleagues and provided these questions to the authors of the chapters. Thus, the goal of these chapters is to help nonsurgeons answer their own questions about common cardiac procedures, and to help prepare these physicians to address the questions raised by their patients. In addition, we hope that insight into these issues will improve communication between surgeons and their col leagues-and, ultimately, lead to better patient care. Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi 1 Chapter 1. Anesthesia for Cardiac Surgery JONATHAN B. MARK Chapter 2. Cardiopulmonary Bypass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 DANIEL FITZGERALD Chapter 3. Myocardial Protection in Cardiac Surgery . . . . . . . . . . . . . . . . . . 23 JEFFREY SELL Chapter 4. Coronary Artery Bypass Grafting . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 HENDRICK B. BARNER Chapter 5. Surgery for Left Ventricular Outflow Obstruction: Aortic Valve Replacement and Myomectomy . . . . . . . . . . . . . ."

Cardiac surgery is performed on hundreds of thousands of patients a year, and can have an important beneficial impact on the outcomes of patients with coronary and valvular heart diseases. Despite the favorable recovery of most patients, some will have their post-operative period interrupted by the development of atrial fibrillation, with a host of potential complications including stroke. High risk subgroups may develop atrial fibrillation in more than half of cases, and often despite aggressive prophylactic measures. Treatment of atrial fibrillation and its aftermath can also add days to the hospital stay of the cardiac surgical patient. In an era of aggressive cost cutting and optimization of utilization of health care resources, the financial impact of this arrhythmic complication may be enormous. Experimental studies have led to a greater understanding of the mechanism of atrial fibrillation and potential precipitating factors in the cardiac surgical patient. Prophylactic efforts with beta-blockers, antiarrhythmic drugs and atrial pacing are being used, or are being investigated in clinical trials. New methods of achieving prompt cardioversion with minimal disruption of patient care, and prevention of the thromboembolic complications of atrial fibrillation, are also important therapeutic initiatives. This text is designed to aid health care professionals in the treatment of their patients in the recovery period after cardiac surgery, and to instigate additional research efforts to limit the occurrence of, and the complications following, this tenacious postoperative arrhythmia.

The book will be written by the experts in the disease including imaging, interventional cardiology and surgical valve expertise. The book has five main sections: Aortic Valve Disease Mitral Valve Disease Tricuspid Valve Disease Pulmonic Valve Disease Multimodality Imaging The main objectives of the book are: 1- to provide the main guidelines to clinicians on how to identify and diagnose valvular heart disease 2- to provide an overview of what the near future will bring in the diagnosis, prevention and risk stratification of patients to catheter versus surgical approaches 3- to outline the possible implications for medical therapies in slowing progression of calcific aortic valve disease and myxomatous mitral valve disease

Implantable defibrillators as originally conceived by Michel Mirowski were limited to the detection and automatic termination of ventricular fibrillation. In the original "AID" device, the detection algoritlun sought to distinguish sinus rhytlun from ventricular fibrillation by identifying the "more sinusoidal waveform of ventricular fibrillation. " The therapeutic intervention was elicited only once deadly polymorphic rhythms had developed. It was rapidly learned, however, that ventricular fibrillation is usually preceded by ventricular tachycardia. Mirowski recognized the pivotal importance of developing algoritllms based on heart rate. Ventricular tachycardia detection allowed the successful development of interventions for the termination of ventricular tachyarrhythmias before they degenerated into ventricular fibrillation. Current device therapy no longer confines itself to tlle termination of chaotic rhythms but seeks to prevent them. Diagnostic algorithms moved upward along the chain of events leading to catastrophic rhytlulls. Rate smoothing algorithms were developed to prevent postextrasystolic pauses from triggering ventricular and atrial tachyarrhytlmlias. Beyond the renaissance of ectopy-centered strategies, long-term prevention received increasing attention. Multisite pacing therapies provided by "Arrhythmia Management Devices" were designed to reduce the "arrhytlunia burden" and optimize the synergy of cardiac contraction and relaxation. Clinical evidence now suggests that atrial fibrillation prevention by pacing is feasible and tllat biventricular pacing may be of benefit in selected patients with heart failure. However, these applications of device therapy that generally require ventricular defibrillation backup remain investigational and were not considered in this book.

ICD therapy has become the standard form of treatment for ventricular tachyarrhythmias. With clinical data showing its efficacy in both secondary and primary prevention of premature sudden death, its use is likely to increase dramatically in the next decade. Technological advancement has been instrumental in simplifying ICD implantation. However, technical additions to the device have also made its scope of functions more complex. In addition to providing rapid and effective therapy for ventricular tachycardia and fibrillation, the ICD is now capable of providing a full spectrum dual-chamber pacing as well as therapies for atrial fibrillation. Soon, it will also be able to provide treatment for congestive heart failure using multi-site ventricular pacing and provide continuous hemodynamic monitoring. This book serves as an introductory text to those who are relatively new to this technology. In its manual form, it outlines the pertinent components of ICD functions and the basic differences among the various models. It provides practical points in ICD implantation, and in its programming and trouble-shooting.

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.

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.

This book covers aspects of new developments in the field of basic electrophysiology, cardiac pacing, implantable defibrillators and addresses socioeconomic aspects related to thse topics. The section on electrophysiology provides a comprehensive overview of basic hardware equipment, sudden death, heart rate variability, signal averaged ECG, RF catheter ablation and clinical decision making. The section on pacing includes overviews on new lead developments, pacing in cardiomyopathy, as well as VVIR & DDIR pacing and automatic mode switching. Finally the section on implantable defibrillator provides a detailed view of clinical and technical aspects of third generation devices. All chapters have been written by world experts in their fields and each chapter is fully illustrated with tables, ECG recordings and black and white photographs. The book should be of use to nurses, technicians, bioengineers, cardiologists, cardiovascular surgeons, health authorities and for all who are involved in the field of pacing and electrophysiology.

In this issue of Thoracic Surgery Clinics, guest editor Dr. Gita Mody brings her considerable expertise to the topic of Global Thoracic Surgery. An all-new topic to Thoracic Surgery Clinics, global thoracic surgery is an essential component of public and global health. In this issue, top experts provide timely insights on training, anesthesia, pathology, radiology, techniques, and surgical management of common thoracic surgeries throughout low-middle income countries (LMICs). Contains 14 relevant, practice-oriented topics including esophageal cancer treatment globally; lung cancer management in LMICs; endoscopy and bronchoscopy in low-resource settings; surgical capacity building for low-resource settings; training general thoracic surgeons in LMICs; and more. Provides in-depth clinical reviews on global thoracic surgery, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

Brain injury is one of the most unacceptable complications sustained during heart surgery. This book presents the current results and thinking of a number of leading clinical investigators in this area. Nearly all have been active in serious studies designed to define various aspects of brain physiology, patho physiology, or protection during cardiac operations performed with cardio pulmonary bypass. We were particularly interested in obtaining contributions from younger investigators. Brain injury is a problem which has long troubled those involved with perioperative care of the cardiac surgical patient. The first chapter by Dr. Torkel Aberg presents a summary of his extensive investigations into this problem. It is intended both to present the perspective of a surgeon interested in this problem, and to serve as an introduction to the overall issue of avoiding brain injury during heart surgery. The next three chapters discuss the problem of perfusion pressure, outcome, and brain blood flow. Dr. Sarnquist's contribution stems from his extensive experience with low flow bypass as practiced at Stanford University and the results of the studies he performed in collaboration with Dr. Fish. Drs. Govier and Reves discuss in some detail the general effects of anesthetic agents upon brain metabolic needs as well as their important data demonstrating preserva tion of brain blood flow autoregulation during cardiopulmonary bypass (CPB) as practiced at the University of Alabama. Finally Dr.

A comprehensive review by renowned authorities of the many exciting developments occurring across the rapidly emerging field of "minimally invasive" or "minimal access" cardiac surgery. The book's distinguished panel of contributors presents the interventional cardiologists perspective, spells out the key factors for success in beating-heart coronary bypass grafting through limited incisions, and surveys the various methods of harvesting the internal thoracic artery. Other topics treated include immobilization of the surgical field, minimal access valve and congenital surgery, alternative methods of anastomosis, and port-access coronary bypass grafting. Minimally Invasive Cardiac Surgery summarizes all the latest findings on the powerful new techniques, as well as the results, of minimally invasive coronary surgery, including valvular heart disease, congenital heart disease, and coronary revascularization.

The treatment of end-stage heart failure with advanced surgical therapies has evolved significantly over the last several years and is a dynamic subspecialty within cardiac surgery. "Surgical Treatmentfor Advanced Heart Failure "describes the surgical management of advanced heart failure, including coronary artery revascularization, mitral valve repair, aortic valve replacement, ventricular remodeling, cardiac resynchronization, mechanical circulatory support with short-term devices for acute stabilization, long-term mechanical support as a bridge to transplant and for destination therapy, left ventricular assist devices, complete cardiac replacement with the total artificial heart, and cardiac transplantation. With contributions from a distinguished group of heart failure cardiologists and transplant surgeons, it is an authoritative resource for cardiac surgeons, cardiologists, and surgeons.

In this issue of Thoracic Surgery Clinics, Guest Editor Cherie Erkmen brings considerable expertise to the topic of social disparities in thoracic surgery. Top experts in the field cover key topics such as social disparities in lung cancer, population health, esophageal cancer, benign lung diseases, and more. Provides in-depth, clinical reviews on social disparities in thoracic surgery, providing actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field; Authors synthesize and distill the latest research and practice guidelines to create these timely topic-based reviews. Contains 12 relevant, practice-oriented topics including Social Disparities Database and Big Data; Health Disparities in Recruitment and Enrollment in Research; Social Disparities in Lung Cancer Risk and Screening; and more.