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Review

What the cardiac surgeon needs to know prior to aortic valve surgery: impact of echocardiography

Medical Clinic II, Cardiology and Angiology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany

Received 14 December 2008; received in revised form 2 February 2009; accepted 9 February 2009.

^_* Corresponding author. Tel.: +49 234 302 6050; fax: +49 234 302 6084. (Email: alfried.germing{at}rub.de).

Echocardiographic assessment prior to valve surgery is crucial for clinical decision making, timing of surgery, planning the adequate surgical therapy and predicting the patient's outcome. Description of transvalvular velocities is not enough for sending a patient to the operating room. There are specific functional and morphological characteristics of each valve dysfunction that have to be addressed by the echocardiographer prior to surgery. Evaluation of the aortic valve, annulus, root, ascending aorta, left ventricular outflow tract and left ventricular function are important. In knowing these characteristics the surgeon may choose the appropriate valve and operation techniques and assess the need for additional surgical procedures. A detailed evaluation of valve morphology and function in context with cardiac hemodynamics should be achieved during echocardiography. This step-by-step evaluation allows the correct diagnosis and classification of patient's outcome. In conclusion, an echohemodynamic approach enables the cardiac surgeon to plan and perform the adequate surgical procedure.

Key Words: Aortic valve disease • Echocardiography • Aortic valve surgery