Echocardiography in the preoperative diagnosis of acquired heart valve diseases

With the aim of minimizing the risk and stress of an invasive diagnostics, 102 patients with acquired heart valve diseases were examined by two-dimensional echocardiography combined with pulsed Doppler technique. The results were compared with those obtained at invasive diagnostics in 91 and/or during surgery in 52 of the patients studied. In the group of operated patients the sensitivity of non-invasive diagnostics was 89.5%, specificity 97.2%; analogous data for patients not subjected to surgery were 91.8% and 93.8%, respectively. The results of the study show that in the majority of patients with acquired valvular disease a complete preoperative invasive investigation is not necessary. Only in patients over 50 years of age the intended valve replacement should be preceded by additional coronarographic examination, as in 6.8% of cases--even without kinetic disturbances at rest--a haemodynamically important stenosis was found on at least one coronary artery.     

风湿性瓣膜病患者冠状动脉疾病预测指标的研究

目的 :研究风湿性瓣膜病患者冠状动脉心脏病 (CHD)的冠状动脉病变分布及CHD预测指标。方法 :对 6 78例风湿性瓣膜病患者行冠状动脉造影检查 ,左右冠状动脉管腔狭窄≥ 70 %、左主干管腔狭窄≥ 5 0 %判定为CHD。结果 :发现并发有CHD患者 (CHD组 ) 86例 ,平均年龄大于非CHD患者 (非CHD组 ) ,多支病变 4 8例(5 5 .81% )。CHD组中家族史、糖尿病、高胆固醇血症多于非CHD患者。有无心绞痛症状与是否并发CHD无明显相关 ,各种瓣膜病变CHD的发生率相似。结论 :CHD家族史、糖尿病、高胆固醇血症是风湿性瓣膜病患者进行冠状动脉造影检查的指征 ,心绞痛不是风湿性瓣膜病患者并发CHD的预测指标     

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)     

The future of catheterization in acquired heart valve diseases

The value of routine catheterization and angiography in the investigation of acquired valvular disease is currently under debate. In many cases, echocardiography provides enough information, even for pre-operative assessment of the heart disease. However, the pre-operative assessment of the valvular disease requires an estimation of the severity of the valvular lesion and a study of left ventricular performance. In older patients, associated coronary artery disease also has to be evaluated. Finally, in patients who have been treated surgically, the disorders related to recurrence of their valvular disease or to the dysfunction of their valvular prosthesis also have to be identified. Each of these aspects has to be considered; this requires a very thorough clinical evaluation of the symptoms and signs and a combination of investigations, consisting of echocardiography, haemodynamic studies and angiography.     

Echography in heart valve diseases]

The authors discuss the value of echorcardiography in cardiac valvular disease. Exploration of the mitral valve gives very precise data concerning diagnosis and evaluation of the degree of mitral stenosis. It may be of value in the diagnosis of certain complications such as intra-atrial thrombosis and gives reliable information in postoperative surveillance. In mitral insufficiency, echocardiography sometimes permits the recognition of certain mechanisms such as rupture of the cordae, ballooning of the lesser cusp and abnormal kinetics in obstructive cardiomyopathy. Exploration of the aortic valve is less informative. Aortic insufficiency gives scarcely any direct signs, whilst echocardiography is of value in aortic stenosis. Ultrasonic study also is useful in surveillance of the kinetics of valvular prostheses. The total absence of risk makes repeated studies possible, rendering echocardiography an essential element in the study of valvular disease.     

Familial occurrence of acquired heart valve defect]

A report is given on a family examination, issuing from 213 persons with an acquired valvular defect for the establishment of further cases on altogether 783 relations of the direct line. In 19 families other 21 patients with an acquired valvular defect were found; this corresponds to a share of 2.7 % of the relations examined and 8.1% of the families affected, respectively. The result repays the expenditure and, apart from this, leads to an essential furthering of the confidence between physician, patient and family as the smallest social unity for prophylaxis, diagnostics, therapy and metaphylaxis of chronic diseases.     

Clinico-diagnostic criteria for the evaluation of social aspects in acquired heart valve diseases

In spite of the retrogression of the acute rheumatic fever the acquired valvular defects still play an essential role for the morbidity and mortality above all for the younger and middle decenniums of life. In the preliminary diagnostics it is the task of the family doctor to diagnose the valvular defect, to differentiate it from non-organic findings and to estimate its degree of severity. The diagnosis of a carditis renders special difficulties, particularly in its chronic recurrent form. Certain situations of life do not demand only an actual analysis of the findings, but also an individual prognostic estimation. For the choice of profession, the ability for military service and driving a car general references and regularities must be taken into consideration. The indication to operation of the valvular defect is generally given in degree of severity and with restriction also in stage IV. A mitral stenosis is operated already in stage II, when stronger complaints and haemodynamic changes are present. Patients with degree of severity III and IV should avoid a pregnancy, in stage I and II under common control by the internist and obstetrician the pregnant patient may not have any scruples to carry to full term.