Diagnostic investigations of adult cardiac disease

Preoperative investigations in cardiac surgery can be divided into two stages: diagnostic studies and assessment of fitness for surgery. Diagnostic investigations are used by cardiologists to detect and evaluate coronary, valvular, myocardial and thoracic aortic disease and, in conjunction with symptoms, are used to determine the appropriate management of cardiovascular disease. Patients presenting for cardiac surgery frequently have significant co-morbidities. Knowledge of these co-morbidities helps to plan the perioperative care of the patient with the aim of reducing postoperative morbidity and mortality thereby maximizing the chances of an uneventful recovery, and allows for more accurate informed consent. The preoperative assessment may also determine a patient to be very high risk for conventional treatment and may steer clinicians to offer patients alternative treatments such as transcatheter aortic valve implantation (TAVI) for severe aortic stenosis. This article highlights the tests for preoperative diagnosis and assessment of fitness for surgery in adult cardiac patients. In combination they guide clinicians in making appropriate management decisions, particularly with regard to elderly, frail or complex cardiac cases discussed in the setting of joint cardiology and cardiothoracic meetings.