DECISIONS concerning the optimal time for cardiac surgery in patients with valvular heart disease are often extremely difficult. Factors to be considered when recommending valve replacement include the patient's symptoms and physical findings; the severity of valvular obstruction or regurgitation, or both; the natural history of the disease process; the presence of normal or abnormal ventricular performance; the presence or absence of coexistent coronary artery disease; and the morbidity and mortality associated with valve replacement.1-5
During the past two decades, cardiac catheterization with cineangiography, and often with selective coronary arteriography, has been the "gold standard" for determining the extent of valvular obstruction or regurgitation, or both, the number of cardiac valves affected, the effects of valvular disease on resting and exercise cardiac hemodynamics, the presence of normal or reduced left ventricular (LV) performance, and the existence or absence of important coincident coronary artery disease. Noninvasive techniques, particularly echocardiography and
O'Rourke RA. Preoperative Cardiac Catheterization: Its Need in Most Patients With Valvular Heart Disease. JAMA. 1982;248(6):745–750. doi:10.1001/jama.1982.03330060075041
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