Related Experiment Videos
[Concomitance of coronary artery disease with acquired aortic valve disease]
I Rawczyńska-Englert1, E Orłowska-Baranowska, M Hoffman
1Instytutu Kardiologii w Warszawie.
Insights
Coronary artery disease is common in patients with acquired aortic valve disease, especially aortic incompetence. Younger patients (<45 years) with valve disease rarely have coronary artery disease.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Clinical Medicine
Background:
- Acquired aortic valve disease is often associated with coronary artery disease (CAD).
- The incidence and severity of CAD in patients with aortic valve disease require further investigation.
- Understanding CAD prevalence is crucial for surgical planning, particularly regarding combined aortic valve replacement and coronary artery bypass grafting.
Purpose of the Study:
- To assess the incidence and extent of coronary artery lesions in patients with acquired post-rheumatic aortic valve disease.
- To determine the correlation between different types of aortic valve disease (stenosis vs. incompetence) and the presence of CAD.
- To evaluate the impact of age on the prevalence of CAD in this patient population.
Main Methods:
- Retrospective analysis of 250 patients with acquired post-rheumatic aortic valve disease treated between 1976 and 1986.
- Hemodynamic examination and selective coronarography performed in symptomatic patients or those over 45 years old.
- Patients categorized into groups based on aortic valve stenosis or incompetence, and age (<45 vs. >45 years).
Main Results:
- Coronary artery disease symptoms were present in 82.8% of patients with acquired aortic valve disease.
- Critical coronary artery stenoses requiring combined surgery were found in 37% of cases.
- Severe coronary artery stenosis was more frequent in patients with aortic valve incompetence (45%) compared to aortic valve stenosis (29.3%).
- Notably, 88.5% of patients under 45 years old with coronary failure symptoms had normal coronary arteries.
Conclusions:
- Concomitant coronary artery disease is highly prevalent in patients with acquired aortic valve disease.
- Aortic valve incompetence is associated with a higher incidence of severe coronary artery stenosis compared to aortic valve stenosis.
- Age is a significant factor, with younger patients (<45 years) demonstrating a low incidence of CAD despite aortic valve disease.
Abstract:
Incidence of concomitant coronary disease and extent of coronary artery lesions were assessed in 250 patients with acquired post-rheumatic aortic valve disease treated between 1976 and 1986 in National Institute of Cardiology. Patients' age ranged from 30 to 72 years. Hemodynamic examination with selective coronarography were performed in patients with typical effort or rest angina pain, with electrographically documented myocardial infarction in the past and also in those without (CAD clinical symptoms, but older than 45 years. Patients were divided into two groups: with isolated or dominated aortic valve stenosis (139 patients) and with isolated or dominated aortic valve incompetence. Patients younger and older than 45 years were separately analyzed. Concomitant CAD was proved if at least one coronary artery stenosis was stated. Lesions degree was proportionally graded: stenosis more than 70%, between 50-70% and 20-50% of a vessel lumen in relation to its diameter before lesion. Data were analyzed using ICL ME 29 computer. Study results indicate, that symptoms of coronary failure were observed in 82.8% of patients with acquired aortic valve disease. In 37% of cases there were critical stenoses requiring simultaneous aortic valve replacement with coronary artery by-pass grafting. Severe coronary artery stenosis was stated in 45% of patients with dominated or isolated aortic valve incompetence, whereas only in 29.3% with dominated or isolated aortic valve stenosis. 88.5% of patients younger than 45 years nevertheless coronary failure symptoms had normal coronary arteries.