Atlas of adult cardiac surgery

Atlas of adult cardiac surgery - William Gay

This atlas of adult cardiac surgery highlights the illustrations of the late R. Leon Schlossberg, long-time medical illustrator at the Johns Hopkins Hospital.

The highlights of this text include well-illustrated chapters on the MAZE Procedure, and Techniques for Hypertrophic Obstructive Cardiomyopathy. The section on the approaches to the mitral valve is very thorough and helpful in understanding techniques to achieve better exposure of the mitral valve.

There are, however, several deficiencies in this text. The section on Port Access Coronary Artery Bypass Grafting describes the technique for a left internal mammary artery to left anterior descending (LIMA-LAD) coronary anastomosis with a submammary incision and femoral artery–femoral vein bypass with Heartport techniques in the arrested heart. Faced with a single LIMA-LAD anastomosis, most cardiac surgeons would use a standard mediasternotomy incision with an off-pump beating heart technique or a minimal access approach using a limited left anterior thoracotomy in the beating heart. Techniques for mitral valve repair have a paucity of illustrations, especially those for the most common technique, the quadrangular resection. There are no illustrations describing the “sliding plasty technique” or techniques for neochordae reconstruction with Gortex suture. The authors' techniques of aortic reconstruction for a DeBakey Type I Dissection include clamping the distal ascending aorta with an atraumatic vascular clamp. As noted by the authors, most surgeons, including myself, would not clamp the aorta but would employ circulatory arrest to examine the arch and perform the distal anastomosis. Following this maneuver, the aortic cannula would be inserted into the ascending aortic graft so that circulation could be resumed in an antegrade fashion, thus minimizing the chance that the dissection would be propagated into the arch and descending aorta. Finally, no mention is made of procedures involving either the tricuspid or pulmonary valves.

Despite these shortcomings, the authors have done a very thorough job in illustrating the major procedures performed in adult cardiac surgery and in describing the advantages and potential pitfalls associated with each procedure. This atlas will be especially valuable to residents and cardiothoracic surgeons who have just started their practices.