Coronary Arteriography in Isolated Aortic and Mitral Valve Disease

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Abstract
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. Of 52 patients, 32 (61%) with AP did not have CAD, and 48 of 10 (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. Of 32 patients, 16 with mitral incompetence had CAD of whom 4 had AP. Of 68 patients, 7 with mitral stenosis or mixed mitral valve disease had CAD. AP was noted by 4 of these 7 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 preoperative assessment of patients aged .gtoreq. 40 yr with aortic valve disease or mitral incompetence. Its value is limited in patients with mitral stenosis or mixed mitral valve disease without AP.