Heart catheterization in the patient with valvular heart disease.

Despite impressive advances in non-invasive technology, cardiac catheterization remains the gold standard for the evaluation of patients considered for valve surgery. Diagnostic information should be combined with non-invasive measurements, particularly serial non-invasive echocardiographic assessments, to allow for optimal management decisions. For adult patients with risk factors for coronary artery disease, we do not believe there is any substitute for selective coronary angiography. The availability of non-ionic contrast agents, pre-assessment by thorough physical examination and non-invasive techniques, allows safe cardiac catheterization even in patients who are severely compromised by congestive heart failure and/or coronary artery disease.