Routine Coronary Arteriography Research Articles

Preoperative prediction of significant coronary artery disease in patients with valvular heart disease.

A prognostic index for predicting significant coronary artery disease was established using multiple logistic regression analysis of clinical data from 643 patients with valvular heart disease who had undergone routine coronary arteriography before valve replacement. The index or equation obtained incorporated the presence of angina, a family history of ischaemic heart disease, age, cigarette smoking habits, mitral valve disease, sex, and electrocardiographic evidence of myocardial infarction. The equation was validated using prospective data from 387 patients with valvular disease and shown to enable almost a third of routine coronary arteriograms to be omitted while maintaining 95% sensitivity for patients with coronary artery disease. Similar analysis of the more detailed prospective data produced a second discriminant function incorporating diastolic blood pressure, total cigarettes smoked in life, the severity of angina, family history of ischaemic heart disease, age, current cigarette smoking habits, and the ratio of total to high density lipoprotein cholesterol. This method improved the discrimination between patients with and without coronary artery disease, allowing omission of 30% of routine coronary arteriograms with 100% sensitivity for patients with coronary disease and omission of 41% with a 96% sensitivity level.

Routine coronary arteriography post myocardial infarction: Another view

Catheterization and Cardiovascular DiagnosisVolume 8, Issue 3 p. 223-224 Editorial Routine coronary arteriography post myocardial infarction: Another view James H. Gault MD, FSCA, James H. Gault MD, FSCA Lancaster, PennsylvaniaSearch for more papers by this author James H. Gault MD, FSCA, James H. Gault MD, FSCA Lancaster, PennsylvaniaSearch for more papers by this author First published: 1982 https://doi.org/10.1002/ccd.1810080303Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume8, Issue31982Pages 223-224 SCAI Member Sign in RelatedInformation

Routine coronary arteriography post myocardial infarction.

Catheterization and Cardiovascular DiagnosisVolume 8, Issue 3 p. 217-221 Editorial Routine coronary arteriography post myocardial infarction Richard K. Mautner MD, Richard K. Mautner MD New Orleans, LouisianaSearch for more papers by this author Richard K. Mautner MD, Richard K. Mautner MD New Orleans, LouisianaSearch for more papers by this author First published: 1982 https://doi.org/10.1002/ccd.1810080302Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume8, Issue31982Pages 217-221 SCAI Member Sign in RelatedInformation

CARDIAC VALVE REPLACEMENT AND CORONARY BYPASS GRAFTS

A retrospective, six-year survey of 72 patients who underwent combined cardiac valve replacement and coronary artery bypass grafting is presented. The average age was 58 years with a male to female ratio of 3.5:1. Eighteen patients were angina-free, their coronary disease being found by routine coronary arteriography. Fifty-eight patients (81%) had aortic valve replacements, 13 patients (18%) had mitral valve replacements, and one patient had a double valve replacement. Forty-one patients (58%) had a single coronary bypass graft. Total cardiopulmonary bypass times averaged two hours, and the average cold myocardial ischaemic time was 60 minutes. The operative mortality in the group was 8%, which did not differ significantly (chi 2 = 0.25; P greater than 0.6) from the operative mortality of 6% in 1400 operations either for single valve replacement or for isolated coronary grafts which were performed in the same six-year period.

Surgical treatment of coronary artery aneurysm with rupture into the right atrium

Considering the increasing number of patients with chest pain who undergo routine coronary artery arteriography, coronary artery aneurysm may be found more frequently. To know how to manage these aneurysms, we must understand their possible complications. The aneurysms can produce symptoms of angina or acute myocardial infarction by total thrombosis of the aneurysm and vessel, embolism to the distal vessel, or progressive enlargement and encroachment upon the distal vessel until it is occluded. Moreover, the aneurysm may enlarge and rupture into the free pericardium or produce a fistula by eroding into a chamber of the heart. The case described herein may represent the first reported case of a coronary artery aneurysm eroding into a cardiac chamber and causing an arteriovenous fistula. The treatment of choice is resection of the aneurysm, closure of the fistula, and re-establishment of continuity of the distal coronary artery with a saphenous vein bypass graft.

Coronary Atherosclerosis in Valvular Heart Disease

To evaluate the usefulness of routine coronary arteriography in patients undergoing cardiac catheterization for the evaluation of valvular heart disease, we performed coronary arteriographic studies routinely in a series of 201 patients primarily catheterized for such evaluation. Coronary artery obstructive lesions in excess of 50% of the lumen were present in 45 of the 201 patients. In 18 of the 45 there was no history of chest pain. Three of the 18 had three vessels involved while 2 had two vessels involved. A total of 27 patients (13.4%) had luminal obstruction greater than 70%, and 9 of these had no pain. In 35 of the 201 patients, classic angina pectoris existed in the absence of radiographically significant disease. Severe coronary disease was found to coexist with hemodynamically severe valvular heart disease and was not predictable noninvasively.

Scanning electron microscopy of surface irregularities and thrombogenesis of polyurethane and polyethylene coronary catheters.

Following routine coronary arteriography, surface irregularities and thrombogenesis of the inner and outer wall of six Ducor polyurethane and six RPX polyethylene coronary catheters were studied by scanning electron microscopy. Polyurethane catheters had rough and highly irregular external and internal surfaces. All catheters showed adherent thrombi on their external surface. The internal surface of three catheters showed evidence of thrombosis. Polyethylene differed from polyurethane in several respects. Although the external surface had an irregular and wavelike appearance, the internal surface was smooth and regular. Two polyethylene catheters showed thrombi on their external surface. The internal surface of one catheter showed single platelets in one area. These results confirm recent reports showing that internal and external surface irregularities play a major role in the initiation of thrombosis in and on intravascular catheters. They stress the need for high quality catheter materials with smooth and regular surfaces in the prevention of thromboembolic complications from coronary arteriography.

Should coronary arteriography be performed routinely before valve replacement?

The implication that coronary atherosclerosis is a common cause of complications and death after prosthetic heart valve replacement has resulted in the performance of routine preoperative coronary arteriography in many clinics. A review of 4 years' experience with such studies at the University of Oregon Medical School Hospital indicates that patients with significant coronary obstruction in conjunction with valvular heart disease always had angina pectoris. None of the postoperative deaths or complications were due to demonstrable coronary artery disease without preexisting angina. It is likely that the increased cardiac work load imposed by valvular heart disease increases myocardial oxygen demands. Significant coronary atherosclerosis is therefore unlikely to remain asymptomatic. Coronary arteriography may be safely omitted before valve replacement in many patients with increased myocardial work who have no symptoms of ischemic heart disease, and who lack risk factors known to increase its incidence.