Assessment of mitral valve disease by left heart catheterization.

Many studies of the pressures in the left atrium and the left ventricle of patients with mitral valve disease have been published. Initially obtained by direct puncture of the cardiac chambers at operation, such recordings have since been made possible by the development of techniques of left atrial puncture as a diagnostic procedure before operation. Direct determinations of the left atrial pressure, the left ventricular diastolic pressure, the diastolic pressure gradient across the mitral valve, and the duration of the diastolic filling period render unnecessary several assumptions that must be made when mitral disease is assessed by right heart catheterization. When mitral stenosis is associated with aortic valve disease, left ventricular failure, or significant mitral regurgitation, the limitations of right heart catheterization may be great, and precise information may be obtainable only by left heart catheterization. Assessment of the relative importance of mitral stenosis and regurgitation when present in combination has remained a difficult problem. Various opinions of the diagnostic value particularly of the left atrial pulse form (Gunning and Linden, 1958; Marshall et al., 1957; and Morrow et al., 1957) and of dye dilution curves (Korner and Shillingford, 1955; Shillingford, 1958; and Woodward et al., 1957) have been expressed. The present report summarizes experience with left heart catheterization in 75 patients with mitral valve disease, with particular reference to the assessment of combined stenosis and regurgitation.