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Angina pectoris in aortic valvular disease and its relation to coronary pathology
Insights
Angina pectoris in aortic valvular disease is often functional, not due to coronary artery blockages. Coronary angiography is crucial before aortic valve surgery to check for blockages and guide potential bypass surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Medicine
Background:
- Angina pectoris is a frequent symptom in patients with aortic valvular disease.
- The cause of angina in this context requires further investigation to optimize patient management.
Purpose of the Study:
- To investigate the prevalence and underlying causes of angina pectoris in patients with aortic valvular disease.
- To determine the necessity of coronary angiography before aortic valve surgery.
Main Methods:
- A study of 100 consecutive patients with aortic valvular disease was conducted.
- Patients were assessed for angina pectoris, aortic stenosis, aortic insufficiency, and coronary artery stenosis via coronary angiography.
Main Results:
- Angina was more common in aortic stenosis than insufficiency.
- Only 21% of patients with angina had significant coronary artery stenosis (>75%).
- Significant coronary artery stenosis was found in 25% of patients without angina.
Conclusions:
- Angina in aortic valvular disease is frequently functional, stemming from an imbalance in myocardial oxygen supply and demand.
- Coronary artery disease may coexist and impact surgical outcomes, necessitating routine coronary angiography before aortic valve surgery.
- Simultaneous coronary bypass surgery should be considered for severe, surgically correctable coronary stenosis during aortic valve replacement.
Abstract:
Angina pectoris is a common symptom in aortic valvular disease. In our study of 100 consecutive patients it was found more commonly in patients with aortic stenosis than in those with aortic insufficiency. Only 21 of 80 patients with angina pectoris had significant narrowing (more that 75%) of one or several coronary arteries. Angina pectoris in aortic valvular disease thus seems to be most often functional due to disproportion between myocardial oxygen supply and demand. On the other hand, 5 of 20 patients without angina pectoris had significant coronary artery stenosis. As coronary artery involvement may jeopardize the results of aortic valve replacement in these patients, coronary angiography should always be carried out in patients evaluated for surgery of aortic vavlular disease. Coronary bypass surgery should be carried out during the same operation if the stenosis is severe and bypass is technically feasible.