Why the study?
What is the prevalence of significant coronary artery stenosis in patients with aortic valvular disease with and without angina pectoris?
What is the prevalence of significant coronary artery stenosis in patients with aortic valvular disease with and without angina pectoris?
Angina in aortic valvular disease is often functional rather than due to coronary artery disease, but significant asymptomatic coronary stenosis can occur, supporting routine coronary angiography before aortic valve surgery.
Angina poorly predicts significant CAD in aortic valve disease; leaves open whether routine preoperative angiography is warranted.
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.
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Storstein et al. (1979) studied this question.
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