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Noninvasive assessment of valvular heart disease: surgery without catheterization
Insights
Selected patients with valvular heart disease can safely undergo valve surgery using noninvasive evaluations alone. This approach avoids cardiac catheterization, reducing costs and potential risks for eligible individuals.
Area of Science:
- Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Background:
- Preoperative cardiac catheterization is traditionally used to diagnose valvular heart disease.
- Noninvasive methods like echocardiography are increasingly sophisticated.
- Patient selection is crucial for determining the necessity of invasive procedures.
Observation:
- Forty-one patients with valvular heart disease underwent surgery based on clinical and noninvasive findings.
- Coronary artery disease patients were excluded.
- 83% of patients were New York Heart Association functional class III or IV preoperatively.
Findings:
- Noninvasive evaluation was sufficient for diagnosis and surgical planning in all patients.
- Cardiac catheterization was omitted in 23 patients due to unstable hemodynamics.
- In 18 patients, catheterization was deemed unlikely to alter management, avoiding cost and morbidity.
- Intraoperative findings confirmed noninvasive diagnoses; no unexpected findings or diagnostic-related deaths occurred.
- Follow-up showed no signs of ischemic heart disease.
Implications:
- Successful valve surgery is feasible using combined clinical and noninvasive assessments in select patients.
- This strategy can obviate the need for preoperative cardiac catheterization.
- It offers a cost-effective and safer alternative for specific patient cohorts without anginal syndromes.
Abstract:
Forty-one patients underwent valve surgery at our institution based solely on clinical, M-mode echocardiographic, phonocardiographic, and external pulse recording findings without preoperative cardiac catheterization. Patients with clinical evidence of coronary artery disease were excluded from the study. Preoperatively, 83% of the patients were New York Heart Association functional class III or IV. In all patients, the noninvasive evaluation was considered sufficiently diagnostic of the nature and severity of valvular heart disease to allow surgery without preoperative catheterization. In 23 of 41 cases (group 1), cardiac catheterization was not performed due to the patients' unstable hemodynamic condition at the time surgery was being considered. In the remaining 18 patients (group 2), the probability of obtaining data at catheterization that would significantly affect management decisions was thought to be low, thus not justifying the cost and potential morbidity of this procedure. In all cases, the noninvasive diagnosis was corroborated at operation; there were no unexpected findings nor deaths related to incomplete or incorrect diagnoses. Over a followup period of 4.5 +/- 1.4 years, no patient experienced signs or symptoms of ischemic heart disease. In selected patients without anginal chest pain syndromes, appropriate and successful valve surgery may be performed on the basis of combined clinical and noninvasive evaluation without the need for cardiac catheterization.