Clinical Application And Significance Of Coronary Angiography In Valve Replacement Patients Of Rheumatic Heart Disease

Objective: To explore the clinical application and significance ofpreoperative coronary angiography in valve replacement patients ofrheumatic heart disease.Methods:313valve replacement patients of rheumatic heart diseasewho underwent preoperative coronary angiography from January2002toJune2012were retrospectively analyzed, and the risk factors of coronaryartery lesions were investigated. All patients were divided into coronaryartery lesions group and non-coronary artery lesions group, and the surgicaleffects between two groups were compared.Results:29patients of coronary artery lesions were found andaccounted for the prevalence rate of9.27%among313valve replacementpatients of rheumatic heart disease. There were no significant correlationsbetween the type of valve lesions and the coronary artery lesions. Thereexisted the independent risk factors of coronary arterial lesions in valvereplacement patients of rheumatic heart disease such as aged over55years old, male and diabetes, etc. Among all29patients in coronary arterylesions group,11patients underwent coronary artery bypass graftsimultaneously during operation, other18patients only experienced valvereplacement(including1patient underwent coronary artery stentimplantation preoperatively).1patient died postoperatively with mortalityof3.45%.284patients in non-coronary artery lesions group wereperformed valve replacement, and5patients died postoperatively withmortality of1.76%. The cardiopulmonary perfusion and aorticcross-clamp time in coronary artery lesions group were apparentlylonger than those in the non-coronary artery lesions group. There wasno significance between two groups in the early postoperative mortality,complication rate, amount of blood lose during operation, ventilatorsupporting time and hospital stay.Conclusion: The prevalence rate of coronary artery lesions in valvereplacement patients of rheumatic heart disease was apparently higher thanthat in the general population with same age. It is suggested that thepreoperative coronary angiography should be routinely carried out to thevalve replacement patients aged over55years old and also should becarried out to those patients aged from50to54years old with theindependent risk factor(male or diabetes)of coronary arterial lesions.Compared to the patients of valve replacement alone, the same surgicaloutcome could be obtained through selecting the appropriate operation and strengthening the perioperative management in the valve replacementpatients of rheumatic heart disease with coronary arterial lesions.