Cardiac Catheterization in Congenital Heart Disease

CARDIAC CATHETERIZATION IN CONGENITAL HEART DISEASE. By Andre Cournand, Janet S. Baldwin, and Aaron Himmelstein. The Commonwealth Fund, New York, 1949. viii + 108 pp. $4. A few years ago congenital heart lesions were looked upon as rather hopeless oddities, but with the brilliant work of the cardiovascular surgeons this concept underwent dramatic revision. Then it became necessary to develop methods of diagnosis commensurate with the rapidly developing surgical procedures. Catheterization of the heart stands out among these diagnostic methods. Perhaps no one has done more to develop this technique than Dr. Cournand and his associates, and in no disease is it more valuable as a precision diagnostic procedure than in congenital heart disease. In this book the authors have presented clearly and critically the methods, hazards, and potentialities of cardiac catheterization, as well as 17 illustrative cases. The use of the Fick principle to calculate blood flow through the pulmonary artery and the systemic vessels is described, as well as is a series of formulae based on the mixing of oxygenated with reduced blood by which the authors are able to calkulate the net blood flow through abnormal vascular channels. It should be pointed out that choice of the proper formula depends on having prior knowledge of the diagnosis, and difficulty might be anticipated in distinguishing between aorticpulmonic shunt with pulmonic insufficiency, and high interventricular septal defect alone or in combination with aortic-pulmonic shunt, although a different formula must be used for each condition. The case studies, besides demonstrating the value of the methods, should be of great help to physicians who are beginning this kind of work. The diagnoses are clearly derived, although some investigators will doubt that, in the presence of a significant degree of pulmonic stenosis, blood would be shunted only from the left to the right ventricle as stated in the comments following case number 13. While no one could deny such a possibility, the usual experience in this type of case is that blood is shunted from the right ventride to the aorta with a resulting arterial blood oxygen unsaturation. The material is well organized and the illustrations and printing are excellent. This book should occupy an important place in every cardiovascular laboratory. FRANK GRAY