THE USE OF ANGIOCARDIOGRAPHY IN THE SELECTION OF PATIENTS FOR MITRAL VALVULAR SURGERY

Abstract

Angiocardiography was used to study 150 patients with mitral disease. A characteristic angiocardiographic pattern was recognized for "pure" mitral stenosis, and a different pattern for "wide-open" insufficiency. Normal subjects showed rapid sequential opacification of the right and left sides of the heart with clearance of all opaque material in 12 sec. or less. In "pure" mitral stenosis the left atrium remained sharply and densely opacified for prolonged periods whereas the left ventricle was poorly opacified and small. In "wide-open" insufficiency the left atrium and ventricle were equally opacified and the left ventricle was enlarged. Varying combinations of stenosis and insufficiency produced gradations between patterns typical for either lesion alone. Typical patterns help in preoperative evaluation of patients when the diagnosis would otherwise be difficult or uncertain. For example, the test was considered valuable in 88 patients with loud apical systolic murmurs; of these, 16 were rejected for operation while 72 were considered suitable for mitral commissurotomy. Angiocardiography readily confirmed the diagnosis in 62 patients with unmistakable signs of "pure" stenosis, but was considered a non-essential test in such patients since clinical diagnostic error was unlikely. Patients with angiocardiographic patterns typical of stenosis have excellent chances for surgical improvement (1) despite clinical findings suggestive of insufficiency, and (2) sometimes even despite the surgeon''s estimate of an initially adequate valve opening or regurgitant jet. The surgeon should be urged to open such valves further when the preoperative angiocardiogram indicated impairment of left ventricular diastolic filling.