Non-invasive preoperative assessment of chronic valvular heart disease by Doppler ultrasound

Between February 1986 and June 1987,306 consecutive patientswere included in a programme of non-invasive preoperative assessmentof valvular heart disease using M-mode and cross-sectional echocardiographyand Doppler ultrasound. In 285 cases (93%), echocardiographyprovided all the necessary preoperative information. Coronaryangiography was performed in 74 patients because of angina andin 55 because of their age. Invasive investigation was neededin 21 cases because of discrepancies between clinical data andecho-Doppler results. The results were definitely misleadingin six patients, mainly due to erroneous assessment of valvularregurgitation. One hundred and ninety one patients underwentvalve surgery (179 evaluated exclusively by echocardiography,79 with coronary angiography as the sole invasive procedure).No discrepancies were observed between echo-Doppler diagnosisand macroscopic evaluation of valvular heart disease at surgery.Operative mortality (3.6%) was not significantly different fromthat observed during the preceeding period when preoperativecatheterisation was performed (3.3%). It is concluded that echo-Dopplertechniques are perfectly satisfactory for the preoperative assessmentof patients with valvular heart disease. Cardiac catheterisationis only infrequently required, although coronary angiographyremains mandatory in a selected group of these patients.