Coronary Arteriography in Isolated Aortic and Mitral Valve Disease

Abstract

Coronary arteriographic findings in 200 patients with isolated aortic and mitral valve disease were reviewed to examine the relationship between obstructive (greater than 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 less than 0.0001). Asymptomatic CAD was more common among patients with mitral incompetence (12/28 vs 3/64 p less than 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 aged greater than or equal to 40 years with aortic valve disease or mitral incompetence. Its value is limited in patients with mitral stenosis or mixed mitral valve disease without AP.

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…The prevalence of CAD in patients with MS (an average of 20%) is lower than in patients with aortic valve disease, 1015,1017,1018,1021,1022 an observation explained principally on the basis of differences in age and gender. Nonetheless, because of the impact of untreated CAD on perioperative and long-term postoperative survival, preoperative identification of CAD is of great importance in patients with AR or MS and those with AS.…”

ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…patients with aortic valve disease (1015,1017,1018,1021,1022), an observation explained principally on the basis of differences in age and gender. Nonetheless, because of the impact of untreated CAD on perioperative and long-term postoperative survival, preoperative identification of CAD is of great importance in patients with AR or MS and those with AS.…”