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

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. (C) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.