Is Right Heart Catheterization Enough Before Valve Replacement Surgery?

Cardiac catheterization prior to valve replacement surgery?

Hello Doctor: I previously asked this question: "The aortic valve and mitral valve have been damaged by bacterial infection and both valves have vegetations, therefore surgical valve replacement is being considered.
A cardiac catheterization is required before the surgery.
However, since both valves have vegetations, entering through the left ventricle is not advisable (due to the risk of dislodging the vegetations and causing a stroke or other complications).
Is it possible to perform coronary angiography through the right ventricle? Will this be effective?" I may not have expressed my question clearly last time.
What I mean is: For open-heart valve replacement surgery, is performing only right ventricular coronary angiography sufficient? Is it of practical use? Is it necessary to check for blockages in the left ventricular coronary arteries to provide substantial assistance for the valve replacement surgery? (Actually, I am not clear about the purpose of performing cardiac catheterization before valve replacement surgery, so I am uncertain whether performing only right ventricular catheterization is adequate or if it has any practical utility.) Could you please clarify this for me? Thank you!

Miss Lin, 30~39 year old female. Ask Date: 2020/08/24

Dr. Wu Xueming reply Cardiology

The catheter entered the right ventricle, and coronary angiography could not be performed.
Coronary angiography must be conducted via the femoral artery or the radial artery, placing the catheter into the aortic coronary artery opening.
Right heart catheterization is performed to measure the pressures and blood oxygen saturation in the right atrium, right ventricle, and pulmonary artery, which is helpful for preoperative assessment.

Reply Date: 2020/08/24

More Info

Before valve replacement surgery, it is essential to have a comprehensive understanding of the patient's cardiac condition, including the status of the coronary arteries. In your case, where there are concerns about the aortic and mitral valves being compromised due to bacterial infection and the presence of vegetations, the approach to preoperative evaluation becomes critical.

Right heart catheterization primarily assesses the right side of the heart and can provide valuable information about pulmonary pressures and right heart function. However, it does not directly evaluate the left heart structures or the coronary arteries. The left heart, particularly the left ventricle and the coronary arteries, plays a crucial role in the overall function of the heart, especially when considering valve replacement surgery.

The primary purpose of performing coronary angiography (which can be done via left heart catheterization) before valve surgery is to identify any significant coronary artery disease (CAD). If significant blockages are present in the coronary arteries, they may need to be addressed either simultaneously with the valve surgery or beforehand. This is crucial because if a patient undergoes valve replacement without addressing underlying CAD, they may experience postoperative complications, including myocardial ischemia or infarction.

In your specific situation, where there is a risk of dislodging vegetations by accessing the left ventricle, it is understandable to be cautious. However, the decision to proceed with only right heart catheterization should be made in consultation with your cardiologist and cardiac surgeon. They may consider alternative imaging modalities, such as non-invasive coronary CT angiography, to assess the coronary arteries without the risks associated with traditional catheterization.

In summary, while right heart catheterization can provide useful information, it is generally not sufficient on its own before valve replacement surgery. A comprehensive evaluation of the coronary arteries is typically necessary to ensure that any significant blockages are identified and managed appropriately. This holistic approach helps to optimize surgical outcomes and minimize the risk of complications. It is crucial to have a detailed discussion with your healthcare team about the best strategy for your specific case, considering the risks and benefits of each diagnostic approach.

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