The timing of this text book by Anthony Chang and Jeffrey Towbin could not be better for paediatric cardiologists, at a time when the new guidelines for diagnosis and management of chronic heart failure in the adult is published by American College of Cardiology together with the American Heart Association. The pace at which the base of knowledge has expanded, and the number of new studies published, there is a need to rethink future management of heart failure in children and young adults. As mentioned by Douglas Mann in his foreword to the first section concerned with the Basic Science of Heart Failure, in an effort to address the critical deficiency in our understanding of the basic mechanism and management of heart failure in children and young adults, Chang and Towbin have assembled a talented group of clinicians and scientists, who have summarized the “state of the art”.
The introductory section begins logically with a chapter on the molecular mechanisms of heart failure, followed by chapters on receptor signalling and inflammatory mediators. The chapters on haemodynamic adaptive mechanisms in heart failure, including cellular adaptation and neurohormonal responses, highlight the important advances that have been made recently in the understanding of cardiac failure. Chapters on pressure-volume analysis, and mechanism of systolic and diastolic heart failure, discuss the fundamentals of myocardial function, followed by a chapter on pulmonary oedema. The next chapter on echocardiography discusses the conventional parameters, as well as the new ones, like Doppler tissue imaging, the myocardial performance index, and colour M-mode flow propagation velocity. The last two chapters in the first section of the book discuss the role of magnetic resonance imaging and cardiac catheterization in the assessment of cardiac failure.
The second section, devoted to Clinical Diagnosis and Management of Heart Failure in Children, starts with consideration of the economic aspects of cardiac failure. The chosen authors then move on to clinical signs and symptoms, and classification of types of heart failure. An entire chapter is devoted to right ventricular dysfunction in the setting of congenital cardiac disease, with suitable discussion of the complex issue of how to evaluate right ventricular function in this setting. Subsequent chapters cover various clinical conditions associated with the failing heart. The chosen authors give a complete picture of the causes, pathophysiology and treatment of cardiac failure in fetuses, neonates, children with congenital and acquired heart disease, and adults with congenital cardiac disease. Still further authors provide further chapters on heart failure associated with pulmonary disease and sepsis. As a testimony to the comprehensiveness of this textbook, note should be taken of two particular chapters, one that deals with management of heart failure in children in the outpatient setting, and another that deals with nursing and psychosocial aspects of cardiac failure.
In the third section of the book, devoted to Medical Treatment for Heart Failure in Childhood, the chosen authors have discussed not only conventional remedies, but also newer drugs and therapies that are on the horizon, including β-blockers, nesiritide, blockers of angiotensin receptors, calcium sensitizing agents, modulation of the cytokine response, endothelin receptor antagonists, vasopressin antagonists, and cardiac resynchronization therapies for heart failure in children and young adults. This section of the book ably bridges the gap in the knowledge between management of heart failure in adults and medical treatment of heart failure in children and young adults.
The fourth, and final section, devoted to Cardiac Surgery for Heart Failure in Childhood, brings together the most up-to-date version of the surgical treatment of heart failure in children, including surgical strategies for ventricular reshaping, valvoplasty, implantable cardioverter defibrillators, mechanical cardiopulmonary support, ventricular assist device support, and cardiac transplantation.
A minor comment is that there is less discussion on metabolic therapy and nutritional aspects of heart failure as seen in children. The coverage of cardiac transplantation is excellent, but was it wise for the authors to list scheme for grading acute rejection prepared by the International Society for Heart and Lung Transplant in 1990, rather than using the criterions as revised in 2004? And, although there is extensive discussion of left ventricular noncompaction in chapter 20, there is less discussion on the objective criterions available to the echocardiographer or the investigator using resonance image to diagnose this increasingly important lesion.
Taken overall, nonetheless, the strengths of this textbook greatly overwhelm any shortcomings of a work in its first edition. A special feature which the reader will find very useful is that each chapter contains a summary of the current state and future trends. The key points at the end of every chapter will also draw the immediate attention of the reader. At the end of book, the appendixes are very useful. I predict that the book will instantly become the unique encyclopaedic resource on the subject of heart failure in children. The book will be of interest to all who care for children with cardiovascular disease and deal with this most difficult problem of cardiac failure.
