Study of Coronary Artery Disease in Single Aortic Valvular Disease

Objectives To analyze the results of coronary angiographies (CAG) in patients with single aortic valvular heart disease; To study the relationship between aortic valve diseases and coronary artery disease (CAD). Methods 105 patients with single aortic valvular heart disease before surgery underwent angiography. The data of clinical characteristics and angiographies were analyzed. Results 51 patients had symptoms of angina pectoris among 105 patients with single aortic valvular heart disease. Seven of them were confirmed coronary artery disease by angiographies. Although the incidence of angina in aortic valve stenosis group was significantly higher than that in aortic valve regurgitation, the probability of combination of CAD in aortic valve stenosis group was similar to the later. However, the probability of combination of CAD in degenerative aortic valve group was significantly higher than the groups of rheumatic, congenitally bicuspid aortic valves, and other causes (p < 0.01 ). Conclusions Angina pe     

Report: Association of coronary artery disease and valvular heart disease in chile

This study analyzes the prevalence of coronary artery disease (CAD) among patients with rheumatic valvular heart disease (VHD) in Chile. Coronary angiography was performed in all patients referred to cardiac catheterization with VHD who were over age 50 years and who had angina or ECG signs of ischemia. A total of 100 patients entered the study. Significant CAD (greater than 50% obstruction) was found in 14% of the cases: 7% in patients with mitral valve disease (MVD), 18% in aortic valve disease (AVD), and 21% in combined mitral and aortic valve disease (MAVD). Angina was present in 14% of the patients with MVD, 63% with AVD, and 53% with MAVD. Only 57% of patients with CAD had angina pectoris; 20% with angina had CAD. Hemodynamic parameters and left ventricular ejection fraction were not correlated with the presence or absence of CAD. We conclude that in patients with valvular heart disease, the incidence of CAD is lower in Chile than previously reported in the English literature. We confirmed the fact that angina is often not associated with CAD, and that CAD is often present in the absence of angina.     

主动脉瓣疾病冠脉造影分析

目的　观察主动脉瓣疾病患者合并冠状动脉病变的发生情况。方法　对 10 5例主动脉瓣疾病不合并二尖瓣病变的患者术前临床资料和选择性冠状动脉造影的结果进行综合分析。结果　 10 5例患者中 5 1例有心绞痛症状 ,心绞痛发生率为 48 6% ,但冠脉造影显示只有 7例诊断冠心病。主动脉瓣狭窄病变为主者心绞痛的发生率为 68 2 % ,以主动脉瓣关闭不全病变为主者 ,心绞痛的发生率为 3 2 0 % ,两者比较有统计学差异 (P <0 0 1)。但是 ,两者冠心病的发病率无统计学差异。主动脉瓣退行性变组合并冠心病率(3 3 3 % )显著高于风心病组和先天性二叶瓣组 (P <0 0 1)。结论　在单纯主动脉瓣病变中以心绞痛预测冠心病的敏感性、特异性、准确率低。而主动脉瓣退行性变合并冠心病的发病率大于风心病和先天性的主动脉瓣病变。在单纯主动脉瓣病变者明确有无合并冠心病 ,冠脉造影是必要的 ,尤其是主动脉瓣退行性变病人     

Rapid development of coronary arterial stenosis following valve replacement: an unusual cause of myocardial ischemia

A 56-year-old woman had unstable angina pectoris 3 months after aortic and mitral valve replacement for rheumatic heart disease. Repeat coronary arteriography revealed critical proximal left anterior descending and circumflex artery stenoses in previously normal coronary arteries. This case emphasizes the need for thorough evaluation of postoperative valvular patients, despite normal preoperative coronary arteriograms.     

Indications for coronary angiography in patients with acquired heart valve diseases with reference to risk factors

The aims of the study were to examine the frequency of coronary artery disease (CAD) in patients with acquired valvular heart disease and to investigate the parameters by which significant coronary artery stenosis can be identified without invasive measures in these patients. For this reason 266 consecutive patients with acquired valvular heart disease (aortic, mitral or combined lesions) were examined retrospectively. In 24 patients (9%) a significant (50% or more reduction of the diameter) coronary artery stenosis was found. The prevalence of CAD increased with age: only one patient younger than 50 years, but 23 patients (13%) older than 50 years revealed significant CAD (19% men, 7% women). Increased levels of cholesterol and/or triglycerides were found more frequently in patients with CAD (33% and 29%, respectively) than in those without (6% and 12%, respectively). No differences were found in patients with aortic and mitral valve disease. Patients with typical chest pain revealed CAD in 30% of cases, whereas only 5% of the patients without angina pectoris (or 4% with atypical chest pain) showed a significant coronary artery stenosis. A high percentage (62%) of patients with typical chest pain and mitral valve disease revealed CAD. None of the 77 female patients without typical angina pectoris had significant coronary artery stenosis, whereas 11% of the male patients showed significant CAD even without typical symptoms. In 51 patients without typical angina pectoris and with no risk factors, no CAD was observed.(ABSTRACT TRUNCATED AT 250 WORDS)     

Incidence of coronary artery disease in patients with valvular heart disease.

The case notes, cardiac catheterisation data, and coronary arteriograms of 239 patients investigated for valvular heart disease during a five year period were reviewed. Angina present in 13 of 95 patients with isolated mitral valve disease, 43 of 90 patients with isolated aortic valve disease, and 18 of 54 patients with combined mitral and aortic valve disease. Significant coronary artery disease was present in 85 per cent of patients with mitral valve disease and angina, but in only 33 per cent of patients with aortic valve disease and angina. Patients with no chest pain still had a high incidence of coronary artery disease, significant coronary obstruction being present in 22 per cent with mitral valve disease, 22 per cent with aortic valve disease, and 11 per cent with combine mitral and aortic valve disease. Several possible clinical markers of coronary artery disease were examined but none was found to be of practical help. There was, however, a significant inverse relation between severity of coronary artery disease and severity of valve disease in patients with aortic valve disease. Asymptomatic coronary artery disease is not uncommon in patients with valvular heart disease and if it is policy to perform coronary artery bypass grafting in such patients, routine coronary arteriography must be part of the preoperative investigation.     

50岁以上瓣膜性心脏病冠脉造影分析

目的探讨老年瓣膜性心脏病合并冠心病的情况。方法96例50岁以上瓣膜性心脏病住院患者,其中男性38例,女性58例,常规予Judkins法经股动脉或桡动脉行冠脉造影。并结合冠心病的危险因素、瓣膜病的病因、病变部位进行多因素分析。结果96例瓣膜性心脏病患者合并冠心病11例,总发生率11.5%。其中风湿性瓣膜性心脏病82例,合并冠心病7例,发生率8.5%,非风湿性瓣膜性心脏病14例,合并冠心病4例,发生率28.5%,两组相比P<0.05。多危险因素组46例,合并冠心病9例,发生率19.6%,少危险因素组50例,合并冠心病2例,发生率4%,两组相比P<0.05。主动脉瓣病变者合并冠心病2例,二尖瓣病变者合并冠心病3例,联合瓣膜病变者合并冠心病5例,各组相比P>0.05。结论瓣膜性心脏病合并冠心病发生率不高且合并冠心病者多为非风湿性病因,其中危险因素组冠心病发生率较高,不同瓣膜病变在合并冠心病发病率上无显著性差异。     

瓣膜性心脏病伴缺血性心脏病的外科治疗

目的 :总结瓣膜性心脏病伴缺血性心脏病手术治疗的早期效果和经验 ,以期提高疗效。方法 :11例患者中 ,行主动脉瓣置换术 4例 ,二尖瓣置换术 2例 ,二尖瓣和主动脉瓣双瓣置换术 1例 ,主动脉带瓣管道置换 2例 ,二尖瓣成形术 1例和三尖瓣成形术 1例 ;搭 1支桥 4例 ,搭 2支桥 1例 ,3支桥 3例 ,4支桥 3例 ,平均 (2 .5±1.3)支。结果 :11例无手术早期死亡 ,痊愈出院 ;随访 2～ 16 (平均 6 .3)个月 ,心绞痛症状消失 ,心功能明显改善。结论 :对年龄 >5 0岁瓣膜病患者或具有冠心病高危因素患者 ,应行冠状动脉造影检查 ;彻底纠正心脏病变 ,加强心肌保护 ;妥善处理术后并发症 ,手术疗效满意     

463例心脏瓣膜病冠状动脉造影分析

目的　观察心脏瓣膜病患者的冠状动脉病变的发生率。方法　对 46 3例心脏瓣膜病患者术前临床资料和选择性冠状动脉造影的结果进行综合分析。结果　心脏瓣膜病并发冠状动脉病变发生率为 16 8% ,其中无症状占 88 3%。结论　年龄大于 5 0岁者 (有冠心病危险因素者提前到 45岁 ) ,心脏瓣膜置换术前应常规行选择性冠状动脉造影检查 ,以减少手术并发症 ,确保瓣膜置换术后复跳成功     

101例老年钙化性心脏瓣膜病临床分析

目的探讨老年钙化性心脏瓣膜病临床特点及其与冠心病之间的关系。方法选择101例经心脏彩超确诊为老年钙化性心脏瓣膜病并行冠脉造影的患者,分析其一般临床资料和冠状动脉造影结果。结果老年钙化性心脏瓣膜病常伴发高血压（59．4％）、脂代谢紊乱（56．4％）、糖尿病（26．7％）和冠心病（75．2％）等疾病,钙化部位以主动脉瓣（92．1％）多见。随着瓣膜钙化部位的增加,患者年龄、冠脉病变阳性率、冠脉Gensini积分均明显升高,三支病变比例亦增多。结论老年钙化性心脏瓣膜病患者具有一定的临床特点,并且多部位钙化患者严重冠脉病变多见。     

成人主动脉瓣疾病冠状动脉造影分析

目的 调查成人主动脉瓣疾病合并冠状动脉硬化性心脏病的情况。方法 成人主动脉瓣疾病需行手术治疗病人211例,根据病情均在术前行冠状动脉造影,分析临床资料及造影结果。结果 211例成人主动脉瓣疾病病人有58例合并冠心病。其中,钙化退行性主动脉瓣组病人合并冠心病显著高于风湿性、先天性及感染性主动脉瓣组。结论 退行性主动脉瓣病常合并冠心病,成人主动脉瓣疾病有心绞痛症状行手术治疗术前应常规行冠状动脉脉造影检查,无心绞痛症状的病人行此检查的年龄应适当放宽。     

冠状动脉旁路移植同期行心脏瓣膜手术的临床研究(附57例报告)

目的:介绍同期施行冠状动脉旁路移植术和瓣膜手术的体会。方法:2000年12月至2006年3月,57例冠状动脉旁路移植术同期行瓣膜手术,患者年龄43~81岁,平均60·5岁,术前心功能(NYHA)Ⅱ级19例,Ⅲ级31例,Ⅳ级7例;二尖瓣病变29例,主动脉病变13例,联合瓣膜病变15例,瓣膜病病因中,风湿性31例,退行性13例,缺血性9例,二瓣化畸形4例。共搭桥103支,平均1·8支,根据患者的年龄及病变血管情况选用乳内动脉、桡动脉及大隐静脉做血管桥。行二尖瓣成形17例,二尖瓣置换12例;主动脉瓣成形10例,主动脉瓣置换12例,二尖瓣和主动脉瓣双瓣置换术6例,同时行三尖瓣成形13例。术中放置经食管超声监测检测瓣膜成形效果。结果:术后早期死亡3例;术后并发症为出血、低心排出量综合征、肾功能不全、肺部感染和小面积脑梗塞。术后6个月复查心脏彩超,瓣膜成形效果满意;术后随访平均13·5个月,无明显心绞痛复发,心功能改善。结论:风湿性瓣膜病患者,有冠心病高危因素的患者,术前应常规行冠状动脉造影检查。缺血性二尖瓣关闭不全患者行瓣膜成形,手术效果满意。综合使用多种成形技术行主动脉瓣成形,取得较好的近中期效果。术中经食管超声检测并结合注水试验对于了解成形术的效果有重要意义。充分的术前准备,恰当地使用主动脉内球囊反搏(IABP)及床旁血滤可提高手术成功率。     

Coronary Arteriography in Isolated Aortic and Mitral Valve Disease

Abstract: Coronary arteriography in isolated aortic and mitral valve disease. A. Saltups. Aust. N.Z. J. Med., 1982, 12 , pp. 494–497.
Coronary arteriographic findings in 200 patients with isolated aortic and mitral valve disease were reviewed to examine the relationship between obstructive (>50% diameter stenosis) coronary artery disease (CAD) and angina pectoris (AP).
Of 100 patients with aortic valve disease, 30 had CAD of whom 20 gave a history of AP. Thirty-two of 52 patients (61%) with AP did not have CAD and 10 of 48 (21%) had CAD without AP. CAD was evenly distributed among patients with aortic stenosis, incompetence and mixed aortic valve disease.
CAD was found in 23 of 100 patients with mitral valve disease. Sixteen of 32 patients with mitral incompetence had CAD of whom four had AP. Seven of 68 patients with mitral stenosis or mixed mitral valve disease had CAD. AP was noted by four of these seven patients but by none of the 61 with normal coronary arteriograms (p <0.0001). Asymptomatic CAD was more common among patients with mitral incompetence (12/28 vs 3/64 P<0.005).
AP was an unreliable marker for CAD in aortic valve disease or mitral incompetence. Conversely, CAD was uncommon without AP in mitral stenosis or mixed mitral valve disease.
Coronary arteriography seems indicated in the pre-operative assessment of patients aged40 years with aortic valve disease or mitral incompetence. Its value is limited in patients with mitral stenosis or mixed mitral valve disease without AP.     

老年钙化性心瓣膜病的临床特点及其对心功能的影响

目的分析老年钙化性心瓣膜病的临床特征，并观察其对心功能的影响。方法经超声心动图检查证实的132例老年钙化性心瓣膜病患者，分为钙化性瓣膜病组和钙化性瓣膜病＋冠心病组，并与同期不伴钙化性瓣膜病的冠心病43例作对照。结果钙化性心瓣膜病以单纯主动脉瓣病变（40．2％）最多见，其次主动脉瓣＋二尖瓣病变（34．8％），功能异常主要为主动脉瓣狭窄、关闭不全、或（和）二尖瓣关闭不全；76．7％病例无明显呼吸困难、晕厥、心绞痛等症状，起病隐匿，55．0％患者缺乏瓣膜病变相关病理性杂音，轻度的钙化性心瓣膜病本身对心脏血液动力学影响较小；钙化性瓣膜病＋冠心病组患者的左心扩大明显，心功能不全发生率高，且左心收缩功能不全的程度较重；老年钙化性瓣膜病心律失常（室性早搏、房颤与病态窦房结综合征、房室传导阻滞）的发生率也较高。结论老年钙化性心瓣膜病早期缺乏特征性的症状和体征，对心功能与血液动力学影响不大，随着瓣膜狭窄和（或）关闭不全的加重，逐渐成为心脏重构和心功能不全的影响因素，若合并冠心病等心肌病变，则会起到加速或加重心力衰竭的作用。     

Coronary atherosclerosis in patients with acquired valvular disease

BACKGROUND: Coronary atherosclerosis often coexists with acquired valvular disorders. There is growing evidence in literature that these two conditions may have common aetiology. AIM: To assess the incidence of coronary atherosclerosis in patients with acquired valvular disorders and to compare clinical parameters as well as the prevalence of risk factors between patients with aortic and mitral valve diseases. METHODS: The study group consisted of 155 patients (101 males, 54 females, mean age 58.2+/-9.7 years) with acquired valvular disorder who between 2000 and 2002 underwent invasive cardiac evaluation in our department prior to planned cardiac surgery. Aortic stenosis was detected in 74 patients, aortic insufficiency -- in 26, mitral stenosis -- in 33, and mitral regurgitation -- in 14 subjects. All patients underwent clinical evaluation, echocardiography, coronary angiography and laboratory tests. RESULTS: Patients with aortic stenosis had similar prevalence of coronary atherosclerosis to patients with aortic insufficiency, and patients with mitral stenosis -- to patients with mitral regurgitation. When the two groups -- patients with aortic valve disease and patients with mitral valve disease were compared, significant coronary lesions were more often detected in patients with aortic valve disease (36% vs 12.8%, p<0.05). Also, patients with aortic valve disorder were older, predominantly of male gender, had more often angina but less often heart failure, and had higher total cholesterol level than patients with mitral valve disease. CONCLUSIONS: Significant coronary lesions are more frequently encountered in patients with aortic valve disorder than in those with mitral valve disease. A high prevalence of atherosclerotic risk factors in patients with aortic valve disease may suggest that this condition has similar aetiology to that of coronary artery disease.     

Angina, coronary risk factors and coronary artery disease in patients with valvular disease. A prospective study

The relationship between coronary risk factors and coronaryartery disease in patients with valvular heart disease was studiedprospectively in 387 consecutive patients undergoing routinecoronary arteriography prior to valve replacement. Coronary artery disease was as common in patients with mitralvalve disease (31.9%) as in those with aortic valve disease(26.8%) Although it occurs more frequently in patients withangina (45.7%) significant coronary artery disease is foundin 19.2% (47 of 245) of those without angina (P<0.001), suggestingthat the presence of angina alone is an unreliable indicatorof significant coronary disease. The prevalence and severityof significant coronary artery disease increases progressivelyas the number of coronary risk factors also increase (P<0.001)but the prevalence is low (3%) in patients in whom both anginaand coronary risk factors are absent. These findings suggestthat preoperative coronary arteriography might be omitted inthis latter group of patients.     

Aortic atheroma: not a sensitive indicators for coronary artery disease in patients with mitral valve disease

Aortic atheroma detected by transoesophageal echocardiography has been reported to be a good prognostic marker for coronary disease on angiography. The value of this detection in valvular heart disease would be to avoid preoperative coronary angiography in asymptomatic patients. The aim of this study was to assess the prognostic value of aortic atheroma in a population with a low prevalence of coronary artery disease in whom transoesophageal echocardiography was systematically performed. In addition, calcification of the aortic knuckle, a marker of atherosclerosis, was analysed by simple chest X-ray. One hundred and ninety two patients (103 men, 89 women; mean age: 63.1 +/- 15 years), operated for mitral valve replacement, underwent transoesophageal echocardiography, angiography, within 6 months, and chest X-ray. The cardiovascular risk factors, presence of aortic atherome, angiographic coronary artery disease and aortic calcification were studied. Aortic atheroma was observed in 72 patients (37.5%), usually in the descending thoracic aorta (73.6%). Coronary stenosis was observed in 36 patients (18.7%). On univariate analysis, aortic atherome predicted coronary stenosis with a sensitivity of 53%, specificity of 66% and positive predictive value of 26% and negative predictive value of 86%, compared with chest X-ray: 71%, 65%, 33% and 90%, respectively. In multivariate analysis, only hypercholesterolaemia, smoking and age predicted the presence of coronary artery disease. The presence of aortic atheroma was not predictive (p = 0.3). The authors conclude that aortic atheroma does not predict the presence of coronary artery disease in a patient population with mitral valve disease and a low prevalence of coronary artery disease. Simple chest X-ray has almost the same diagnostic value. The association of these two investigations does not give sufficient negative predictive values to avoid coronary angiography.     

Angina pectoris in severe aortic stenosis

We studied the value of angina pectoris as a predictor of significant coronary artery disease (CAD) in very elderly patients with severe aortic stenosis (AS). The study population consisted of patients with age at least 70 years who were referred for balloon aortic valvuloplasty (n = 90 patients). Routine coronary angiography was performed before the valvular intervention. Patients were grouped according to the presence or absence of angina pectoris. Of the patients with angina pectoris, 78% had obstructive (>50% diameter stenosis) CAD on coronary angiogram, while only 17% of patients without angina pectoris had obstructive CAD (p < 0.01). Angina pectoris had a sensitivity of 78% and a specificity of 82% for prediction of obstructive CAD. This suggests that in elderly patients with severe AS, the presence of angina pectoris is a strong determinant of CAD, and the absence of angina strongly suggests absence of obstructive CAD. In a very elderly population, appropriate decision-making with respect to AS management should not await diagnostic coronary angiography.     

Prevalence and predictors of significant coronary artery disease in Turkish patients who undergo heart valve surgery

BACKGROUND AND AIMS OF THE STUDY: The presence of significant atherosclerotic coronary artery disease (CAD) in patients with valvular heart disease is an important predictor of perioperative mortality. The prevalence of CAD in patients undergoing valvular heart surgery is 20-40% in industrialized countries. The study aim was to determine CAD prevalence in Turkish patients undergoing valvular heart surgery, and to identify predictors of its presence. METHODS: A total of 760 patients (357 males, 403 females; mean age 54.4+/-18.1 years) who underwent coronary angiography before valvular surgery between 1995 and 2000 was enrolled retrospectively. Single- and multi-valve involvement was present in 46% and 54% of patients, respectively. Patients with ischemic mitral regurgitation were excluded from the study. Significant CAD was defined as the presence of > or =50% diameter stenosis anyone of the coronary arteries. The presence of angina pectoris, and of risk factors (e.g. hypertension, smoking, diabetes mellitus (DM), hyperlipidemia, family history of CAD) were sought in all patients. Predictors of CAD were identified by logistic regression analysis. RESULTS: Significant CAD was present in 15.8% of patients (24% males, 9% females) (p <0.001); the highest prevalence was in those with aortic stenosis (p <0.05). CAD was not seen in young patients (aged <45 years) with none of the above-mentioned risk factors. The highest correlation between CAD and risk factors was family history of CAD, followed by DM, hyperlipidemia, hypertension and smoking, in decreasing order. CONCLUSION: The study results showed that CAD in patients with valvular heart disease was less prevalent in Turkey than in industrialized countries. The incidence of coronary lesions rises notably from the age of 50 years in both males and females. Coronary angiography before valvular heart surgery could be omitted in young patients (age <45 years) with none of the coronary risk factors, or without angina.     

Surgical implications and results of combined aortic valve replacement and myocardial revascularization.

To better define the indications for and results of simultaneous aortic valve replacement and myocardial revascularization, a cohort of 271 patients with angiographically defined coronary anatomy who underwent xenograft bioprosthetic aortic valve replacement were analyzed. Two hundred and twelve patients had predominant aortic stenosis, and 55 had pure aortic regurgitation. Discordance between the clinical assessment of angina and the angiographic assessment of coronary artery disease was apparent in 39 percent of the patients with aortic stenosis and 45 percent of the patients with aortic regurgitation. Thirty-seven percent of patients in the aortic stenosis subgroup without angina and 41 percent of patients in the aortic regurgitation subgroup without angina had hemodynamically significant coronary artery disease. Concomitant coronary artery bypass grafting and aortic valve replacement were performed in 101 patients. The incidence of perioperative myocardial infarction and operative death was significantly greater (P < 0.05) in the subsets of patients with coronary disease than in those without coronary disease (9.9 percent versus 0.7 percent and 8.3 percent versus 2.2 percent, respectively). Late postoperative angina and myocardial infarction also correlated with the preoperative presence of coronary artery disease. Excluding operative mortality, the late actuarial survival rate (mean follow-up, 1.6 years; maximal follow-up, 4.9 years) was not statistically lower for the patients with coronary disease.It is concluded that angina pectoris in patients with aortic valve disease is not a reliable indicator of coronary artery disease and that patients with coronary disease who undergo aortic valve replacement have an increased risk. It is inferred from this study that preoperative coronary arteriography is advisable in most adults undergoing the evaluation of aortic valve disease and that simultaneous aortic valve replacement and myocardial revascularization may provide some protection against late attrition due to the combined effects of coexistent aortic valve and coronary artery disease.