Outpatient Diagnostics

In addition to having their medical history taken and undergoing a physical examination, outpatients have the following tests performed: ECG, laboratory tests, and transthoracic echocardiography. This is followed by a detailed discussion of all findings. In special indications, pulmonary function tests, ergometric and spriroergonometric evaluation, Holter ECG, cardiac computed tomography (CT), magnetic resonance imaging (MRI), and transesophageal echocardiography (TEE) are also performed.



In Hospital Invasive Tests

If interventional or surgical therapy is indicated in addition to drug therapy, most patients require invasive diagnostics including left and right heart catheterization. Subsequently, all findings are discussed at the weekly cardiological-surgical conference. Based on this discussion, further therapeutic steps are recommended. In some cases, especially in younger individuals and in subjects presenting with interatrial communications, no invasive diagnostics are required. In these cases, TEE with or without three-dimensional image reconstruction, CT, or MRI are adequate preoperative diagnostic tests.



Special Tests

Three-Dimensional (3D) Echocardiography

Especially in mitral or aortic regurgitation, the question arises if reconstructive valve surgery is an option. Therefore, surgeons need additional information on the morphology and function of the valvular components and their spatial relationship to surrounding structures. Reconstructive valve surgery is generally aimed for if specific conditions are fulfilled. With TEE based 3D echocardiography, the predictive value of diagnostics with respect to the possibility of valve reconstruction can be increased to more than 90%. In addition, 3D echocardiography facilitates a minimal invasive approach, especially in mitral valve surgery. The method helps significantly to limit the surgical trauma for many patients and to shorten the hospital stay by allowing a minithoracotomy.
3D TEE is also employed in order to optimize catheter-interventional therapies such as device closure of atrial septal defects and mitral valvuloplasty and to lower periinterventional risks. Prior to interventional device closure of atrial septal defects, 3D echocardiography displays the tissue rim surrounding the interatrial communication. This is needed to assess if there is sufficient hold for the device. Prior to mitral valvuloplasty, the evaluation of fused commissures is of utmost importance to predict postinterventional result, especially the occurance of mitral regurgitation due to valvuloplasty.

Stress Echocardiography

This method is employed to detect ischemia, particularly if coronary heart disase is suspected in patients with valvular heart disease. The method can also determine the left ventricular contractile reserve in aortic valve disease, confirming the indication for surgery. Echocardiography is also performed in patients with hypertrophic cardiomyopathy and aortic stenosis in order to determine exercise dependent pressure gradients.