Q. How to investigate aortic stenosis by Cardiac Catheterization?
The indications are to confirm hemodynamics when the non-invasive tests are not conclusive or there is a discrepancy between clinical evaluation and echocardiographic findings. It is also done pre-operatively to obtain coronary angiography if associated CAD needs to be ruled out. During cardiac catheterization right and left heart pressures and all necessary gradients should be measured in a meticulous manner. Transvalvular gradients, cardiac out put should be measured to calculate aortic valve area. Crossing a calcified degenerated aortic valve should be avoided unless it is clearly indicated. If entering left ventricle is not possible by retrograde approach transeptal puncture may be done to assess left ventricle to aorta gradient. When clinical impression correlates well with non-invasive evaluation-invasive hemodynamic evaluation with all its complications can be avoided.