Need for cardiac catheterisation in assessment of patients for valve surgery.

Abstract

One hundred and six consecutive patients with valvular heart disease, in whom valve surgery was considered on clinical grounds, were studied prospectively to assess how frequently and accurately the need for valve surgery and the operation required could be specified on non-invasive grounds alone. All patients were assessed non-invasively using clinical details (history and examina- tion), the electrocardiogram, chest x-ray film, and M-mode echocardiography; two dimensional echocardiography was also performed in 65 patients. On the basis of this non-invasive assessment alone the patients were assigned to group A if a definite surgical recommendation, including the operation required, could be made, or group B if catheterisation was judged necessary before such a recommendation could be made. After they had been assigned to group A or B all patients were catheterised. There were 62 patients in group A; subsequent catheterisation and surgical findings confirmed that the surgical recommendation based on the non-invasive findings was correct in all patients. In 16 of these patients the surgeon was requested to operate on a specified valve or valves and also asked to inspect a further valve or valves about which there was some doubt. In only six of these patients did the subsequent catheter resolve this doubt before operation. The remaining 44 patients were placed in group B. The most frequent reason for catheterisation was doubt about severity of the valve lesion (24 patients). Such doubt was significantly more frequent in aortic or combined aortic and mitral valve then in mitral valve disease. Nine of the 24 patients had echocardiograms which were interpreted as showing that valve disease was definitely mild, and in all nine subsequent catheterisation proved this correct; therefore, the experience gained from this study