Without a doubt, the major changes that have taken place in the last few decades in the field of congenital heart disease have been driven by technological progress in imaging, catheterization, and heart surgery. These changes are characterized by the speed at which they occur and also by their complexity, and therefore clinicians need to update their knowledge continuously to keep abreast of such changes. The advantage, on the other hand, is that few disorders are now considered to be completely irremediable. In fact, it is estimated that about 85% to 90% of children born with heart disease now reach adulthood. Thus, a new patient population has emerged of adolescents and adults with complex congenital heart disease who have received conventional surgery or procedures with percutaneous techniques, which bring their own sequelae and complications. Pediatric cardiologists, in turn, are faced with new and fast-changing diagnostic and therapeutic challenges, while their counterparts with adult patients have to tackle problems that were hitherto unknown to them. In both cases, this Spanish-language manual on congenital heart disease in children and adults is helpful because it offers comprehensive, up-to-date clinical, diagnostic, and therapeutic information on the different heart disorders. It also has a specific section, albeit somewhat limited, on congenital heart diseases in adults.
The book brings together the work of authors from various countries (Argentina, Bolivia, Brazil, Colombia, Cuba, Ecuador, Peru, and Spain). The authors are all experts in the various fields that address congenital heart disease. The various chapters discuss genetics, clinical practice, diagnostics, treatment, etc., with highly relevant sections such as Arrhythmias in children and adults, Cardiomyopathies, Pulmonary hypertension, and Congenital heart disease and pregnancy, all written by different authors who are extremely knowledgeable in their fields of interest, as can be judged by the content.
The authors, and in particular the editor, Dr Raul Ríos Méndez, have structured the information superbly throughout the 632 pages, divided into 56 chapters and 11 special topics. Not only is there a detailed description of the different entities involved in heart disorders, but the first chapters are devoted to genetics and heart embryology, which help readers gain a better understanding of the developmental disorders that stem from a specific heart defect. The chapters in the “General” section are also extremely useful with regard to the pathophysiological aspects of hemodynamic patterns, such as increased pulmonary blood flow or pulmonary ischemia, seen in congenital heart disease. Some chapters, such as those that deal with vaccines, normal echocardiographic anatomy, syncope, etc., may seem rather basic for most well-versed pediatric or adult cardiologists, but they take up only a small amount of space, do not detract from the other chapters, and in fact broaden the potential reader base.
The different disease entities are particularly well presented. These topics start with a short description, and continue with details on history, pathophysiology, age-related hemodynamic development, clinical manifestations, signs and symptoms, diagnostic methods, and possible medical and surgical treatments, with a special section on indications and contraindications for surgical and percutaneous techniques. This provides a very broad, in-depth, and up-to-date perspective on each disease. In my opinion, however, it is important to note that although the guidance on treatment provided in the book stems from broad experience in managing a large number of patients, it cannot necessarily be fully extrapolated to treatment protocols in other hospitals. This is to be expected in our specialty, because we often do not have sufficient-sized studies to support some of our treatment decisions. This is where logic, experience, and consensus provide the best guide. In any case, and returning to the book, space limitations may have restrained the authors from commenting on aspects that are still a subject of debate in some areas. This could lead readers to place too much confidence in the treatment decisions described, which do not necessarily reflect an absolute reality.
The book's main drawback is its poor format. In terms of size, it is convenient to carry around and almost pocket-sized, but this is achieved at the expense of small font size and minimal line spacing, and this affects readability. This particularly applies to the figures. The book has an extraordinary total of 450 highly interesting and very useful figures, including echocardiographic planes and magnetic resonance and computed tomography images. Not only are these figures key to understanding anatomic and functional changes, but they also play a substantial and even essential role in reaching a diagnosis. For this reason the poor quality of the images is disappointing. The figures are too small, which makes it almost impossible to see what the author is commenting on. In addition, the different anatomic structures of the heart are labeled with unintuitive symbols bearing no relation to the initials that are routinely used in Spanish. These may well facilitate subsequent editions in other languages, but are an extra source of confusion for readers. Furthermore, although there is an initial section entitled “Color atlas,” with a collection of 32 color figures (some with accompanying explanatory diagrams), it is far removed from the chapter that details the relevant defect and, surprisingly, the corresponding figure is also reproduced in that chapter, but printed in grayscale. Readers therefore have the added inconvenience of having to jump from one chapter to another. Finally, and this may be corrected in future editions, there are some typographical errors and some left-right descriptions of figures, although, in general, these can be readily understood by readers.
In short, this is a good book that, in view of its valuable and proliferative use of figures, could benefit from a better quality edition.