Impact of Noninvasive cardiology on The Definitive Diagnosis of Valvular Disease: Is Cardiac Catheterization Necessary Before Cardiac Surgery?

Abstract

During the past decade significant strides have been made in the noninvasive cardiac diagnosis. This is mainly due to new innovations in the ultrasound and Doppler technology. Phonocar diography is much less commonly used today, and then only as an adjunt to echocardiography. Nuclear imaging and more recently introduced cine CT imaging are noninvasive procedures. While 2-D echocardiography gives us details of anatomical structure, Doppler is extremely useful in evaluating interacardiac flow disturbance. The combinatin of these two techniques has made noninvasive diagnosis very precise. The role of these modalities will now be discussed in detail for each cardiac valve. The degree of valve insufficiency may then be assessed by contrast echocardiography during cardiac catheterization, thus limiting the amount of radiopaque contrast medium which can be toxic to heart and kidneys. As experience is being gained in these noninvasive techniques, more cardiologists feel confident in advising cardiac surgery, in selected patients, without cardiac catheterization. The potential fiscal impact of this change is evident.