A pocketful of heart valves

This well presented pocket manual is part of the Dx/Rx Cardiology series. Written by clinicians from the Division of Cardiovascular Medicine at the University of Massachusetts Medical School, USA, it succeeds in providing, to quote the editor, “a clinical, concise and practical resource…” with which to approach cardiac valve disorders. Their aetiology, pathophysiology, natural history, clinical presentation and physical examination are discussed, followed by the diagnostic evaluation required and the suggested therapy — whether medical, interventional or surgical.

The text is presented in a bullet-point format, aided by tables and figures throughout. Pertinent references are provided at the end of each chapter. Unfortunately, however, there are no illustrations of the various valvular abnormalities, which would have been helpful.

The manual is more relevant to an adult population, although providing a considerable amount of information on congenital abnormalities of the valves. Aortic and mitral valve disease is reviewed in great detail with particular attention given to acquired valvular disease, especially rheumatic fever. Attention is also given to the less common disorders affecting the tricuspid and pulmonary valves.

There is an excellent chapter on prosthetic valves, describing the types used, their specific clinical findings and the details of their assessment and follow-up requirements. Details of anticoagulation for mechanical valves are provided, including a special reference to difficulties associated with pregnancy. Homografts and autografts are briefly described. Infective endocarditis is referred to, where appropriate, throughout the text.

Although aimed at postgraduate students, the manual may be a helpful resource for the busy clinician, whether general physician or family practitioner, as well as the practising cardiologist, for whom there is detailed information available related to less commonly used investigations, such as Doppler echocardiography to determine valve orifice size.

While one could take issue with specific comments or details provided, I do think this well written manual achieves its goal. It may prove invaluable in the consulting room and may also become a welcome guide for interns, residents and registrars working in busy hospital settings. Within its small size, it contains a considerable amount of up-to-date information, clearly and concisely presented.

Samuel MenahemCardiologist Monash Medical Centre and Royal Children’s Hospital, Melbourne, VIC