Mitral regurgitation cardiac catheterization
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed A. Sbeih, M.D. [2]
Overview
Left ventriculography and hemodynamic assessment by cardiac catheterization might be useful to evaluate mitral regurgitation when the results of the non-invasive testing are insufficient.[1] In addition, cardiac catheterization might be performed when there is lack of correlation between the clinical findings and the results of the non-invasive testing in order to rule out cardiac etiologies or pulmonary hypertension as the cause of the patient's symptoms.[2] In patients with mitral regurgitation who have risk factors for coronary artery disease, such as advanced age, hypercholesterolemia, and hypertension, or when there is a suspicion that mitral regurgitation is ischemic in origin, coronary angiography should be performed before surgery.
2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary[2]
Recommendations for Chronic Primary Mitral Regurgitation
Cardiac Catheterization Recommendations
| Class IIa |
| "1. Exercise hemodynamics with either doppler echocardiography or cardiac catheterization is reasonable in symptomatic patients with chronic primary mitral regurgitation (MR) where there is a discrepancy between symptoms and the severity of MR at rest (stages B and C). (Level of Evidence: B) " |
Exercise Testing Recommendations
| Class IIa |
| "1. Exercise treadmill testing can be useful in patients with chronic primary mitral regurgitation to establish symptom status and exercise tolerance (stages B and C). (Level of Evidence: C" |
Recommendations for Chronic Secondary Mitral Regurgitation
| Class I |
| "1.Noninvasive imaging (stress nuclear/positron emission tomography, CMR, or stress echocardiography), cardiac CT angiography, or cardiac catheterization, including coronary arteriography, is useful to establish etiology of chronic secondary MR (stages B to D) and/or to assess myocardial viability, which in turn may influence management of functional MR. (Level of Evidence: C)" |
2008 and Incorporated 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) [3]
Cardiac Catheterization Indications (DO NOT EDIT) [3]
| Class I |
| "1. Left ventriculography and hemodynamic measurements are indicated when noninvasive tests are inconclusive regarding severity of MR, LV function, or the need for surgery.(Level of Evidence: C) " |
| "2. Hemodynamic measurements are indicated when pulmonary artery pressure is out of proportion to the severity of MR as assessed by noninvasive testing.(Level of Evidence: C) " |
| "3. Left ventriculography and hemodynamic measurements are indicated when there is a discrepancy between clinical and noninvasive findings regarding severity of MR.(Level of Evidence: C) " |
| "4. Coronary angiography is indicated before mitral valve repair or mitral valve replacement in patients at risk for CAD.(Level of Evidence: C) " |
| Class III |
| "1. Left ventriculography and hemodynamic measurements are not indicated in patients with MR in whom valve surgery is not contemplated.(Level of Evidence: C) " |
Sources
- 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease [3]
References
- ↑ Nishimura RA, Carabello BA (2012). "Hemodynamics in the cardiac catheterization laboratory of the 21st century". Circulation. 125 (17): 2138–50. doi:10.1161/CIRCULATIONAHA.111.060319. PMID 22547754.
- ↑ 2.0 2.1 Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0000000000000029. PMID 24589852.
- ↑ 3.0 3.1 3.2 Bonow RO, Carabello BA, Chatterjee K; et al. (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Unknown parameter
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