Our patient’s diagnosis has been well defined by bedside findings and non-invasive laboratory assessment. Invasive diagnostic procedures are not mandatory in a 37-year-old woman with neither symptoms nor risk factors for coronary artery disease and with an otherwise completely congruent non-invasive laboratory evaluation. The following catheterization findings are from a similar 40-year-old woman with significant mitral stenosis and chest pain suspicious for coronary artery disease.
Cardiac catheterization for hemodynamic assessment should be performed when non-invasive tests are inconclusive or when there is a discrepancy between non-invasive tests and clinical findings.
Indications for cardiac catheterization prior to valve surgery include chest pain or other objective evidence of ischemia, decreased left ventricular systolic function, history of coronary artery disease, risk factors for coronary artery disease, men more than 35 years of age, premenopausal women more than 35 years of age with risk factors, and postmenopausal women.
In this patient, cardiac catheterization and angiography were performed to determine the status of the patient’s coronary arteries, further define anatomy, confirm the severity of the lesion, detect any associated disease, evaluate left ventricular function, and obtain hemodynamic measurements, including pressures and cardiac output.