Invasive haemodynamic assessment
Summary
Haemodynamics are currently assessed by non-invasive Doppler echocardiography in most patients with structural heart disease. Thus, cardiac catheterisation is now performed principally in patients with complex haemodynamic challenges where questions remain after non-invasive testing. Current assessment of patients with structural heart disease in the catheterisation laboratory therefore requires a robust understanding of invasive haemodynamics and meticulous attention to performance of the procedure and interpretation of the results. This chapter reviews the current role, methods, and limitations of cardiac catheterisation for invasive haemodynamic evaluation.
Introduction
Cardiac catheterisation emerged in the 1960’s as the gold standard for the haemodynamic evaluation of valvular lesions and myocardial disorders. In the 1980’s, two-dimensional and Doppler echocardiography facilitated the non-invasive assessment of patients with structural heart disease through visualisation of valve morphology and ventricular remodelling, as well as measurements of transvalvular gradients, intracardiac pressures and cardiac output. Thus, invasive assessment with cardiac catheterisation is now indicated only when there is structural heart disease which cannot be assessed completely by the comprehensive echocardiogram. With the growing emergence of structural heart disease interventions, there is now a need to provide accurate assessment of haemodynamics before and after intervention.
The increasing complexity of patients coming to the catheterisation...
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