[Heart valve surgery only after heart catheter study?].

Recently British authors have postulated that in potential candidates for valvular surgery cardiac catheterization can be reserved for a minority of selected situations: when there is discrepancy between clinical and echocardiographic findings, when there is clinical evidence of a diseased ascending aorta and when there is clinical suspicion of coronary artery disease. In order that this manner of proceeding can be generally accepted two basic requirements must be fulfilled: First, in the majority of valvular patients, clinical examination and non-invasive tests including echocardiography, Doppler and radionuclide investigations should be sufficiently reliable not only to make a correct diagnosis but also to assess correctly the severity of the valvular lesion; second, the presence of significant coronary artery stenoses which would render necessary coronary artery bypass grafting in addition to valvular surgery would have to be excluded unequivocally by non-invasive means. In most instances severe valvular stenoses are correctly assessed by non-invasive means although misinterpretations may occur, such as in elderly patients with depressed cardiac output. In patients with moderately severe stenoses decision making based on non-invasive measurements as to whether valvular surgery should be carried out or not is much more difficult because of the limited accuracy of the non-invasive determination of valvular area (2D-echo) or pressure gradient (Doppler). Isolated massive valvular regurgitations can be quantitated by radionuclide angiography. Less severe regurgitations in combined lesions and regurgitations across both the mitral and the aortic valves however, cannot be quantitated by these techniques.(ABSTRACT TRUNCATED AT 250 WORDS)