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[Coronary angiography in the preoperative exploration of non-ischemic acquired valve diseases]
Insights
Coronary arteriography in patients with heart valve disease, especially those over 50, can identify coronary artery disease. This aids surgical decisions, particularly for mitral valve disease patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Background:
- Heart valve disease is common, often requiring surgical intervention.
- Coronary artery disease (CAD) can coexist with heart valve disease, impacting surgical risk and strategy.
- Pre-operative assessment is crucial for optimizing patient outcomes.
Purpose of the Study:
- To evaluate the utility of routine pre-operative coronary arteriography in patients undergoing evaluation for aortic and mitral valve disease.
- To determine the incidence of significant coronary artery disease in patients with and without angina symptoms undergoing valve surgery.
Main Methods:
- A retrospective study of 159 patients with aortic valve disease, mitral valve disease, or combined disease.
- All patients underwent pre-operative haemodynamic study and coronary arteriography.
- Coronary arteriography was performed routinely for patients >50 years or selectively for those with chest pain.
Main Results:
- Coronary artery disease was detected in 22% of aortic valve disease patients and 35% of mitral valve disease patients with chest pain.
- No significant CAD was found in patients without angina, except for three cases of mitral stenosis.
- CAD contraindicated surgery in 3 cases and necessitated additional bypass grafting in 7 cases.
Conclusions:
- Routine coronary arteriography in patients over 50 undergoing valve surgery provides valuable information and enhances surgical decision-making.
- While having minimal impact on surgical decisions in asymptomatic patients, it offers added security.
- The routine use is particularly justified in patients with mitral valve disease.
Abstract:
One hundred and fifty-nine patients with aortic valve disease (86 cases), mitral valve disease (58 cases) or mitral and aortic disease (15 cases) underwent a pre-operative haemodynamic study, including coronary arteriography either as a routine (age greater than 50 years) or because of chest pains. Coronary arteriography is easy to do during left heart catheterisation and nowadays carries minimal risk. In the cases of chest pains, it showed stenotic lesions of the coronary vessels in 22% of patients with aortic valve disease and in 35% of those with mitral disease. In the absence of angina, coronary arteriography showed no evidence of coronary artery disease in the cases of mitral regurgitation and of aortic valve disease. In contrast, it showed stenotic lesions in three cases of mitral stenosis. In the whole of the series, coronary artery disease proved a contra-indication to surgery in three cases, and was an indication for aorta-coronary by-pass grafting, in addition to valve surgery, in seven other cases. In the absence of angina, coronary arteriography has only a slight influence on the decision to operate. It does however give additional security, which justifies its routine use in patients over 50 years of age, particularly those with mitral valve disease.