RESUMEN
BACKGROUND AND PURPOSE: The indication for preoperative coronary angiography in patients with valvular heart disease depends on the prevalence of coronary disease in these patients, which differs among different geographical areas. Our aim was to determine the indication criteria for preoperative coronary angiography in our population. METHODS: We studied retrospectively the prevalence of significant coronary disease in 511 consecutive patients with valvular disease diagnosed by non-invasive methods, who underwent preoperative coronary angiography from August/1991 to July/1996. We analyzed in each patient: demographic data, symptoms and presence of risk factors for coronary artery disease. We considered that preoperative coronary angiography had to be performed on patients who had a coronary artery disease prevalence > or = 5%. RESULTS: Mean age was 64 +/- 10 years (51% male). There was mitral valvulopathy in 135 patients, aortic in 234 and combined mitro-aortic in 142. Angina was present in 30% of patients, and risk factors for coronary artery disease in 52%. The prevalence of significant coronary disease was 20.3%. It was significantly higher in patients with angina (35.3% versus 13.8% in patients without angina) and in those with risk factors (28% versus 12.2% in patients without risk factors); no differences between valvulopathies were found. Age was significantly higher in patients with coronary disease (69 +/- 8 versus 63 +/- 10 years). Multivariate analysis showed three independent predictors for significant coronary disease: 1) age; 2) previous angina, and 3) risk factors. Regarding the prevalence of significant coronary disease in patients neither angina nor risk factors was < 5% in males who were under 60 years old (1 man; 3.3%) and in females under 65 years old (2 women; 3.5%). CONCLUSIONS: In our reference population and in others with a similar cardiovascular profile, preoperative coronary angiography is indicated in males who are > or = 60 years old and in females who are > or = 65 years old, and in younger patients who present angina or risk factors, regardless of the valvulopathy present.
Asunto(s)
Angiografía Coronaria , Válvulas Cardíacas/diagnóstico por imagen , Válvulas Cardíacas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios , Estudios RetrospectivosRESUMEN
BACKGROUND AND PURPOSE: Continuity equation to measure aortic valve area is limited by poor acoustic window or difficulty in obtaining acceptable Doppler signal. Our aim has been to analyze the accuracy of planimetry by transesophageal echocardiography to calculate aortic valve area and the impact of calcification on results. METHODS: Planimetry of aortic valve area by transesophageal echocardiography has been compared to continuity equation by transthoracic approach and the Gorlin formula in 26 consecutive patients with aortic stenosis. Degree of calcification was qualitatively estimated by the 3 methods and 2 groups were distinguished: group A (mild or moderate calcification) and group B (severe calcification). RESULTS: An excellent agreement between continuity equation and the Gorlin formula was found (mean difference: 0.03 +/- 0.15 cm2). Agreement between transesophageal planimetry and the Gorlin formula was poor (mean difference: 0.14 +/- 0.25 cm2). Planimetry and the Gorlin formula demonstrated an excellent agreement in group A (mean difference: -0.03 +/- 0.17 cm2). By contrast, agreement in group B was not acceptable (mean difference: 0.27 +/- 0.22 cm2). CONCLUSIONS: 1) continuity equation by transthoracic echocardiography is useful in calculating aortic valve area. 2) aortic planimetry by transesophageal echocardiography is an excellent method in noncalcified aortic valves, and must not be used on severely calcified valves.