Table Of ContentTextbook ofA ngiology
Springer Science+Business Media, LLC
Textbook ofA ngiology
John B. Chang, MD, FACS, FICA
Editor
Associate Editors
Earl R. Olsen, MD, FICA
Kailash Prasad, MD, PhD, FRCP(C) , FACC, FICA
Bauer E. Sumpio, MD, PhD, FICA
With 984 Figures
Springer
John B. Chang, MD, FACS, FICA· Earl R. Olsen, MD, FICA
Chairman, Board of Directors Treasurer and Member,
International College of Angiology, Inc. Board of Directors
and International College of Angiology, Inc.
Director
Long Island Vascular Center
1050 Northern Boulevard
Roslyn, NY 11576
USA
Kailash Prasad, MD, PhD, FRCP(C), FACC, FICA Bauer E. Sumpio, MD, PhD, FICA
Member, Board of Directors Vice President, Scientific Council
International College of Angiology, Inc. International College of Angiology, Inc.
and and
Associate Member Division of Vascular Surgery
Department of Medicine Department of Surgery
University of Saskatchewan College of Medicine Yale University School of Medicine
Saskatoon, Saskatchewan New Haven, CT 06510
Canada USA
Library of Congress Cataloging-in-Publication Data
Chang, John B.
Textbook of angiology / John B. Chang, Kailash Prasad, Earl R.
Olsen, Bauer E. Sumpio
p. cm.
Includes bibliographical references and index.
ISBN 978-1-4612-7039-3 ISBN 978-1-4612-1190-7 (eBook)
DOI 10.1007/978-1-4612-1190-7
1. Blood-vessels-Diseases. I. Prasad, Kailash. II. Olsen, Earl
R. III. Sumpio, Bauer E. IV. Title.
[DNLM: 1. Cardiovascular Diseases. 2. Blood Vessels-physiology.
3. Blood Vessels-physiopathology. WG 120 C456t 1998]
RC691.C518 1998
616.l'3-dc21
DNLM/DLC
for Library of Congress
Printed on acid-free paper. 98-17068
© 2000 by Springer Science+Business Media New York
Originally published by Springer-Verlag New Yark, Inc. in 2000
Softcover reprint of the hardcover 1st edition 2000
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9 8 765 4 3 2 1
ISBN 978-1-4612-7039-3
This book is dedicated to all the devoted men and women
who work so diligently in the field of angiology.
John B. Chang, MD, FACS, FICA
Editor
Preface
Cardiovascular disease is the greatest killer of people in the industrialized nations.
With the advances in science during the past decade, our understanding of the dis
ease has increased much more than anticipated. Yet no matter how many goals
have been realized and what progress has been made, we are still appalled by the
increase in the incidence of cardiovascular disease, its inexorable progression in
In
those afflicted, and the high morbidity and mortality rates. some areas our un
derstanding of essential basic issues still remains incomplete, imprecise, and
clouded by equivocal evidence. It is these problems that dictate the nature of our
pursuits for understanding the disease processes and enhancing the capabilities of
diagnosis, prevention, and treatment of vascular diseases be it medical or surgical.
Although major achievements have been made, they are only minuscule compared
with what remains to be achieved.
We have made the most ambitious and formidable undertaking of compiling this
book in an attempt to summarize our present knowledge of the understanding of
the pathophysiology of vascular diseases, diagnostic modalities, preventive mea
sures, and treatment by medical and surgical means. Information on all aspects of
vascular disease has become vast. Thus a single book can no longer adequately
cover every aspect of the subject. We have, therefore, selected topics that focus on
the important advances in cardiovascular disease that have occurred during the
past decade.
We have made an effort to ignore the classical disciplinary boundaries of the
medical sciences because they are felt to be irrelevant for the organization of this
book. Angiology is a unique discipline that covers all diseases related to blood ves
sels, including coronary artery disease, hypertension, atherosclerosis, stroke, and
peripheral vascular disease. The field of angiology brings together basic scientists
and clinicians to enhance our understanding of cardiovascular disease and to im
prove health care delivery. The interdisciplinary exchange of information and
opinions is important because vascular diseases comprise multiple pathophysiolog
ical disorders, which are expressed as basic disturbances in the integrative physiol
ogy and biochemistry of organ systems. We have attempted to consolidate the
knowledge from all disciplines to amplify our understanding of the mechanisms of
vascular disease and improve the diagnosis and treatment of these diseases.
This book covers the basic physiological principles of angiology, the pathophysi
ology and mechanism of disease processes, diagnostic principles, and the prevail
ing treatments. Topics encompass the integrative control mechanisms, the role of
oxygen free radicals in peripheral vascular disease, the mechanism of atherosclero
sis, thrombotic and embolic arterial occlusive diseases of the extracranial carotid
artery, the aortoiliac segment and visceral arteries, deep vein thrombosis and pul
monary embolism, arterial-venous malformations, aneurysmal diseases of the aorta
vii
Vlll Preface
and peripheral arteries, and ,the essentials of anesthesia for cardiovascular proce
dures. Specifically, we have included topics on valvular heart disease, Lyme disease,
hypertension, coronary artery disease and bypass surgery, thromboangiitis obliter
ans, coarctation of the aorta, dissecting aortic aneurysms, the subclavian steal syn
drome, thoracic outlet syndrome, popliteal artery entrapment syndrome, vasculitis,
diabetic vascular disease, endoluminal grafting, Behcet's disease, renovascular dis
ease, Marfan's syndrome, Budd-Chiari's syndrome, vascular trauma, venous
diseases of the upper extremity, occlusive vascular disease in cancer, lymphade
nopathy, and phlebology.
The chapters have been organized to provide an overview of the disease in the in
troduction, the description of the pathophysiology, a characterization of the clini
cal features, a discussion of the diagnostic modalities, and an assessment of current
treatments. We hope that this format will be conducive for facilitating the manage
ment of patients.
The contributors of the chapters in this book have provided a comprehensive
and authoritative text on the latest concepts in our basic understanding of the
pathophysiology of the disease, and for diagnosis and treatment. This book not
only examines the mechanism of the disease, application of modern invasive and
noninvasive diagnostic techniques, and the management of patients, but also
stresses the rationale, techniques, and indications of vascular and cardiac surgery.
Particular consideration has been placed on what is considered the cutting-edge of
concepts for understanding the pathophysiology of the disease, 'and for diagnosis
and treatment. Where concepts are still ambiguous, multiple authorship has con
tributed to diverse opinions on some topics. We believe that this book embraces the
state of the art for practicing physicians and surgeons, the cutting edge of knowl
edge in the understanding of vascular disease, and the latest developments con
cerning the pathophysiology of the disease.
This is the first written in English book on angiology that encompasses every dis
cipline related to blood vessels. Thus, this book should be of value for physicians,
surgeons, basic scientists, medical students, residents, interns, and related health
care professionals. Health professionals in the field of angiology should find this
book very useful in their practice. We hope to continue with further editions of this
book to update the changing advances in angiology.
We wish to express our sincere thanks to the contributors, whose names and affil
iations are listed elsewhere, for giving their time and effort in making this book
possible. The close relationship among the authors contributes to the strengths of
this book. We also wish to express our appreciation to our many associates and col
leagues who, being experts in their fields, reviewed the chapters and have helped
us with their constructive criticism and helpful suggestions.
Editor and Associate Ed~tors
Acknowledgmen ts
A book of this magnitude and scope could not have been written without the assis
tance and forbearance of numerous individuals. All contributors, reviewers, and
the people behind the scenes truly deserve my sincere thanks and appreciation for
their roles in the realization of this dream. I extend my profound gratitude to the
associate editors and chapter coordinators for their painstaking work that made it
possible to undertake and successfully complete this book. I would like to congrat
ulate Springer-Verlag for their outstanding job in producing this book. I thank Ms.
Denise M. Rossignol, Executive Director of the International College of Angiology,
for her valuable assistance in establishing prompt and timely communications be
tween contributors and the editor. I would also like to thank my associate,
Theodore Stein, PhD, for his editorial assistance. Finally, I take this opportunity to
express my eternal gratitude and love to Lucy J. Chang, MD, my dear wife and life
time partner, for her endless support, unwitting sacrifices, and understanding.
John B. Chang, MD, FACS, FICA
Editor
IX
Contents
Preface ............................................................ vii
Acknowledgments .................................................... ix
Chapter Coordinators ................................................ xx
Section 1 Basic Physiologic Principles in Angiology ...................... 1
1 Structure and Function of Various Vascular Beds ... : .................. 3
Kailash Prasad
2 Endothelial Modulation of Vascular Tone ........................... 11
Johan Van de Voorde and Bert Vanheel
3 Peripheral Circulation and Its Control Mechanism ................... 39
Kailash Prasad
4 Blood Pressure and Its Control Mechanism ......................... 46
Kailash Prasad
5 Coronary Vasculature and Endothelium ............................ 55
Rolf Bunger and Patricia A. Gwirtz
6 Pathophysiology of Atherosclerosis ................................ 85
Kailash Prasad
7 Cellular Mechanisms of Myocardial Hibernation,
Stunning, and Ischemic Preconditioning .......................... 106
Herwig Koppel, Ernst Pilger, and Robert Gasser
8 Calcium Antagonists and Ischemic Heart Disease .................... 112
Andrea Obernosterer and Robert Gasser
9 Basic Mechanisms of Action of Nitrovasodilators and
Development of Tolerance to Organic Nitrates ..................... 122
Johan Van de Voorde and Marc Bogaert
10 Coronary Microcirculation ...................................... 132
M. G. Trivella and G. Pelosi
xi
11 Occupational Cardiovascular Risk Factors .......................... 141
Francesco Tomei, Tiziana Paola Baccolo, Arianna Izzo, Bruno Papaleo,
Benedetta Persechino, Enrico Tomao, and Maria Valeria Rosati
12 Pathophysiological Basis of the Acute Coronary Syndromes ........... 162
Kurt Huber and Fritz Kaindl
13 Clinical Subsets ............................................... 171
Otmar Pachinger and Hitz Kaindl
14 Echocardiography in Coronary Artery Disease ...................... 177
S. Globits, A. Hassan, M. Zehetgruber, and D. H. Glogar
15 Intravascular Ultrasound ........................................ 196
Franz F. Weidinger, Paul Yang, and Ali Hassan
16 Magnetic Resonance Imaging in Cardiovascular Disease .............. 208
Herbert Frank and Sebastian Globits
17 Nuclear Cardiology ............................................ 236
Hans Martin Hoffmeister
18 Medical Treatment of Coronary Artery Disease ..................... 267
MingK Heng
19 Cardiovascular Manifestations of Lyme Disease ..................... 287
Peter Lercher, Renate Schollnast, and Robert Gasser
20 Minimally Invasive Direct Coronary Artery Bypass or
Limited Access Myocardial Revascularization ....................... 293
Vardhan J Reddy and Denton A. Cooley
21 Aortic Insufficiency ............................................ 304
Jacquelyn A. Quin and John A. Elefteriades
22 Valvular Heart Disease: Mitral Stenosis ............................ 318
David W Drucker and John F. Setaro
23 Valvular Heart Disease: Mitral Regurgitation ........................ 322
Habib Samady and John F. Setaro
24 Mitral Valve Prolapse ........................................... 328
Lynda E. Rosenfeld
25 Treatment of Mitral Valve Disease ................................ 334
John A. Elefteriades and John Setaro
26 Prosthetic and Homograft Heart Valves ............................ 347
Ozuru o. Ukoha and John A. Elefteriades
27 Techniques for Interventional Catheterization Guided by
TransesophageaIEchocardiography ............................... 366
Faruk Erzengin and Kemalettin Biiyiikoztiirk
28 Percutaneous Mitral Balloon Valvuloplasty ......................... 370
Mehmet Meri{:, Nevres Koylan, and Kemalettin Biiyiikoztiirk
