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[Coronary lesions due to aortic valve disease. I -- Occurrence and clinical prognosis]
Insights
Coronary arteriography is recommended before aortic valve surgery for most patients to detect significant coronary artery disease. Exceptions include young patients or those in congestive heart failure, where the risk outweighs potential benefits.
Area of Science:
- Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Context:
- Aortic valve disease often coexists with coronary artery disease.
- Pre-operative assessment is crucial for surgical planning and patient outcomes.
- Coronary arteriography is a key diagnostic tool in cardiovascular medicine.
Purpose:
- To determine the indications for pre-operative coronary arteriography in patients undergoing aortic valve surgery.
- To evaluate the prevalence and predictors of significant coronary artery disease in this population.
Summary:
- A retrospective study of 467 patients with operated aortic valve disease found significant coronary artery disease in 15% of cases.
- Prevalence was higher in patients with angina (17%) and specific clinical factors, but these were not specific predictors.
- Coronary arteriography is generally advised for all patients, except the very young or those with severe congestive heart failure.
Impact:
- Highlights the importance of routine coronary arteriography to avoid missed diagnoses before aortic valve replacement.
- Suggests selective use in specific patient groups (young, severe heart failure) to mitigate procedural risks.
- Informs clinical decision-making regarding pre-operative cardiac evaluation in aortic valve disease.
Abstract:
A multicentre retrospective study of 467 cases of operated aortic valve disease was undertaken to define the indications of coronary arteriography in the pre-operative work-up. Significant coronary artery disease was present in 15% of all cases or, more precisely, in 17% of cases with angina and in 8% when investigation was only routine. Coronary artery disease was more frequent in males, in patients with clinical or electrical evidence of previous myocardial infarction, in patients with ST-T wave changes, and when angina was severe (more than one attack per day). None of these factors was specific. It is therefore difficult to limit coronary arteriography to these patients or there would be a risk of missing significant lesions in a small number of cases. It is important to give the surgeon all the necessary information before aortic valve replacement and so coronary arteriography should be widely practiced in this context. However exceptions may be made for young patients and also those in congestive cardiac failure in whom coronary arteriography represents an unnecessary risk before surgery.