The dance along the artery The circulation on the lymph Are figured in the drift of stars. T. S. Eliot Die Methode ist alles. Carl Ludwig In physiology a spirit of finesse is required. Claude Bernard Armed with modern Doppler instrumentation, scientists can now quantify the red blood cell's "dance along the artery" as well as "the drift of stars. " In disciplines of science and medicine ranging from cardiology to astronomy, the Doppler principle now provides invaluable velo city measurements in the microcosm of capillary beds and in the cosmos. The newest appiication of the ubiquitous Doppler...

Cardiac surgery is performed on hundreds of thousands of patients a year, and can have an important beneficial impact on the outcomes of patients with coronary and valvular heart diseases. Despite the favorable recovery of most patients, some will have their post-operative period interrupted by the development of atrial fibrillation, with a host of potential complications including stroke. High risk subgroups may develop atrial fibrillation in more than half of cases, and often despite aggressive prophylactic measures. Treatment of atrial fibrillation and its aftermath can also add days to...

In May 1990, the First International Symposium on Congenital Heart Disease in Adolescents and Adults was organized in Rotterdam. During these three days' Symposium an overview of the many new problems facing the adult and pediatric cardiologist as well as the cardiac surgeon in this rapidly increasing subgroup of the adolescent and adult cardiac population was given. Chal lenges, controversies, uncertainties and questions were presented and discussed with great enthusiasm. We are greatful that most speakers who participated in this symposium, were willing to write a chapter on their presented...

Intracoronary ultrasound is a rapidly evolving imaging modality and the increasing number of published studies indicates that the technique is safe and provides incremental and more detailed diagnostic information than coronary angiography.
The technique has the potential to study the pathobiology of atherosclerosis, to clarify the significance of angiographically equivocal lesions and has helped us to understand the mechanisms, effects and complications of catheter-based revascularization procedures. Combinations of imaging and therapeutic devices are being developed for both guidance...

Quantitative coronary angiography has become an invaluable tool for the interventional cardiologist, providing objective and reproducible measurements of coronary artery dimensions, which can be used to study progression or regression of coronary atherosclerosis, as well as the immediate and long term effects of percutaneous interventions. Until recently, this powerful imaging technology was confined to a small number of so-called high level institutions. Fortunately, with the development of digital cardiac imaging equipment and adaptation of cine-angiographically based computer software for...

As the life expectancy of patients with arterial hypertension increases, hypertension in the elderly is becoming a relevant medical and social problem. Indeed, epidemiological trials have shown that the cardiovascular risk in elderly hypertensives is significantly higher than in normotensive subjects of comparable age. However, many characteristics of hypertension in the elderly, such as the haemodynamic pattern, do differ greatly from those of younger hypertensives and therefore the results obtained in younger patients cannot be extrapolated to older hypertensives.
In this book,...

Pediatric cardiology is celebrating in the 1990s the 50th anniversary of the beginnings of the age of therapy.
This informal history' describes how the discipline grew from the era of pathologic anatomy to the dawn of therapy, the beginnings of closed heart surgery between 1939 and 1945. That dawn ushered in a remarkable half century of change and growth, leading from clinicophysiologic correlations through the start of open heart surgery in the 1950s. The text celebrates some of the achievements of this vivid and heroic age, and describes how, in the mid 1970s, new surgical and medical...

The spectrum of unstable coronary syndromes has been the object of steadily increasing research particularly in respect of novel diagnostic and treatment modalities. Although the WHO criteria for the diagnosis of acute myocardial infarction have been known for decades, there is still much debate as to the proper use of these, especially the handling of biochemical markers. Traditional enzymes have limitations in diagnostic power and new markers have unclarified applicability with regard to standardisation of assays and decision limits. Furthermore, the growing understanding of the conception...

Improving our insights into the genetic predisposition to cardiovascular disease is one of the most important challenges in our field in the next millennium, not only to unravel the cause of disease but also to improve the selection of patients for particular treatments. Nowadays, for example, subjects with a cholesterol above a particular plasma level are exposed to a cholesterol lowering regime based upon the beneficial outcome of epidemiological studies which include subjects not prone to the disease, despite a plasma cholesterol above the accepted level. Identification of the patients who...

A little bit more than two years after the first edition, we are pleased to publish the second edition of this book. More than half of the chapters have been remodeled and completed as the result of technical improvements and recently acquired clinical data. During these two years, the number of coronary pressure measurements performed worldwide both during diagnostic and interventional procedures has increased almost exponentially. Most of the initial problems associated with this new approach have been overcome. Many colleagues have explored new research avenues and in many catheterization...