Cardiovascular Failure Fourth Edition

CABRERA FISCHER, EDMUNDO IGNACIO; STEIN, A. J.; BALAGUER, J.

del Valle

Lugar: Buenos Aires; Año: 2005 p. 261

950 9591 57 2

During the last decades, pharmacological and surgical procedures that aid the diseased heart function have successfully determined significant improvements in cardiac disease survival. Yet, children and young men continue to die from circulatory failure, while impairment of quality of life afflicts a growing number of aged patients with heart failure. In the XVII century, the famous treatise by William Harvey concluded with the mystery of blood circulation. Many years later, Lael Wertenbaker in his book ?To Mend the Heart? ends the chapter ?Eras of Change in the Evolution of Cardiac Surgery? in the year 1967 when cardiac transplantation was performed for the first time in human subjects. Heart replacement changed the ominous destiny of a patient suffering from severe chronic heart failure. However, it has since become apparent that cardiac transplantation, with limited organs and high costs, marks not the end but perhaps only a turn in the history of this condition. Progress in heart failure knowledge has been reached by genetic, molecular and cell biology concepts, leading not only to a more comprehensive and accurate understanding of the pathophysiology of this disease but also to subsequent therapeutic approaches. Continuous research in basic and clinical science has also led to improvements in diagnostic, prognostic and treatment techniques. Progress in the medical treatment of heart failure may be changing the natural history of this old syndrome. This fact, added to the surgical treatment of cardiac diseases and the aging of the world population, has led to an increase in the total number of patients with this condition, patients that in the past may have died but now have a longer life expectancy. Treatment of heart failure using mechanical devices has been extensively employed since Adrian Kantrowitz, in the last half of the 20th century, developed the aortic counterpulsation procedure. The results obtained with this technique, successfully used in acute cardiac failure, encouraged a search for an alternative in chronic heart failure. In fact, in 1968 Denton Cooley in Texas, U.S.A., removed the heart of a dying patient and implanted an artificial pump made by Domingo Liotta (born in Entre Ríos, Argentina) for the first time in a human being. Surgical treatment of cardiac failure was one of René Favaloro?s dreams. In 1970 he published the results of a series of 191 resections of ventricular aneurysms in his book ?Surgical Treatment of Coronary Arteriosclerosis?, emphasizing the high mortality due to heart failure in these patients. Later, in 1980, Dr. Favaloro?s tireless interest in achieving the implantation technique of the total artificial heart and his relation with Dr. Willem Kolff, Director of the Artificial Organs Department of Utah University, allowed that complex technique to be implemented in Argentina. With its rising prevalence, chronic cardiac failure is not only a medical syndrome but also a social and economic concern. The public health perspective insists on optimizing the primary care of these patients, instead of individualizing in patient management of advanced heart failure. The history of cardiac failure therapies include: introduction, adoption and abandonment. Only large controlled trials can determine the real value of new (and sometimes old) medical and surgical treatments of hear failure. At present, it is evident that great numbers of effective treatment strategies are improving both, the quantity and quality of these patients. This edition encompasses topics from different fields related to cardiovascular failure. It attempts to attack this seemingly insurmountable problem that is beset by economical and social issues, by predominantly trying to explain the basic principles that rule in medicine. To achieve this end, it was necessary to invite experts in their respective fields to participate in this endeavor. This book not only comprises subjects that deal with the heart itself, but also with the vessels that interact with the heart and with the techniques employed that aid the heart attain its function. It is very important to take all these factors into account since each individually can modify the heart?s condition to the extent of impairing it. Pathological as well as physiological explanations are introduced in many chapters with the objective of familiarizing the reader with the details of medical syndromes. Medicine is an art that collects information from the basic sciences and uses the technological advances from engineering in order to provide better care for our patients. This book intends to accomplish the task of bridging the engineering and medical field through some of its chapters which include the characteristics of the engineering equipment that is commonly used in the operating room. In this world where technology surpasses the limits previously set, it is necessary to be able to contemplate and consider the new devices that can help physicians with the goal of soothing the patients suffering. Furthermore, it is also compulsory to understand the main principles drawn from the basic sciences to be able to grasp or have a clearer idea of the heart?s physiopathological state. The heart does not achieve its function only by itself, but through a myriad of regulatory processes and coupling. The ones that we consider the most important are described in this book. We know that physicians measure the value of a book on the basis of how it may ultimately help them to cure a disease better. This book provides a selection of contributions in an attempt to supply physicians and researchers with current concepts and knowledge in the domain of cardiovascular failure, one of the most important causes of hospital admission and mortality. Controversies on several issues may be expected, as all of them are the result of evolving spheres of research on heart failure and are intended to be an optimal approach to this syndrome. Also, we would like to acknowledge, with very real gratitude, the scrupulous work of a number of individuals who reviewed aspects of the text, corrected the style, and offered many helpful suggestions on the manuscripts. Finally, we would like to gratefully appreciate the contribution of all the authors of this edition, actively involved in writing chapters and providing valuable and practical advice.