Preoperative invasive testing in mitral stenosis: indications based on assessment of diagnostic yield

The role of preoperative invasive testing in mitral stenosis was assessed in 82 patients undergoing cardiac catheterization for isolated mitral stenosis. The patients were diagnosed by physical examination and echocardiography and were considered for surgical treatment primarily to relieve dyspnea. They had no precordial murmur attributable to an aortic valvular lesion and had no history of chest pain. The presence of mitral stenosis was confirmed at catheterization in all patients. All 38 patients in New York Heart Association functional class III and 8 of 9 patients in class IV had hemodynamic confirmation of mitral disease warranting operation. Although a mitral gradient was present in all 35 patients in class II, operation was not recommended in 9 (26%) of 35 with normal or mildly elevated pulmonary arterial wedge pressure. Invasive testing did not increase preoperative knowledge of aortic. tricuspid, or pulmonary valvular lesions which required surgical treatment. Coronary arteriography was performed in 44 patients (54%) and identified 4 patients with luminal narrowing (greater than 70% diameter reduction) affecting 1 or 2 arteries. These results suggest that preoperative invasive testing in patients with mitral stenosis is unnecessary when symptoms are moderate to severe and clinical evidence of aortic valvular or coronary artery disease is absent. However, preoperative cardiac catheterization is indicated in patients with mild symptoms to avoid unnecessary or premature mitral valve operations.