Cardiac catheterization. Indications in patients with valvular heart disease

AS WITH any diagnostic procedure, the decision to perform cardiac catheterization must be based on a careful balance of the risk of the procedure against the anticipated value of the information. The risk of cardiac catheterization is relatively easy to assess and is low in patients with valvular heart disease, mortality being less than 0.4% in a cooperative study involving 16 catheterization laboratories.1The value of the resulting information is more difficult to define, and in general, elucidation of its meaning requires knowledge of the natural history of the patient's specific disorder. In our institution, cardiac catheterization is recommended in patients with valvular heart disease when there is a need to confirm the presence of a clinically suspected condition, define its anatomic and physiologic severity, and determine the presence or absence of associated conditions. Generally, this need arises when clinical assessment suggests that the patient is approaching, but has