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[Retrospective study of the role of systematic coronarography in patients with heart valve diseases].

The aim of this study was to assess retrospectively the valve of routine coronary angiography in the investigation of patients with valvular heart disease. Between 1978 and 1981, 598 patients over 40 years old underwent left heart catheterisation with routine coronary angiography. In the group with a medical history of angina or infarction (N = 149), there were 49 cases (33%) of severe coronary artery disease (greater than or equal to 70%) and 17 cases of moderate coronary artery disease (11%); of the 49 patients with severe lesions, 2 died after catheterisation, 8 were considered to have too high an operative risk because of their coronary disease and 19 were operated. Valve replacement was associated with a procedure for myocardial revascularisation in 15 cases. In the group without angina (N = 449), severe coronary lesions were much less common (3.6%) and only 5.1% had moderate coronary disease. Severe coronary lesions were found more frequently in certain sub-groups: Stage IV dyspnoea (9%), patients over 65 years of age (11.5%), and coronary calcification (24%). Of the 39 patients without angina and over 50% narrowing on coronary angiography, 17 underwent isolated valve surgery, and 9 underwent combined valvular and coronary surgery (2% of catheterised patients without angina; 3.5% of patients operated without angina. These results show that routine coronary angiography is fully justified in patients with valvular heart disease and a history of angina as vital information is obtained in a high proportion of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[Epidemiology and etiology of acquired heart valve diseases in adults].

Acquired valvular heart disease remains common. Their causes have changed during the past 30 years with the increase in life expectancy and with the decrease in the incidence of rheumatic fever. Calcific aortic stenosis is currently the predominant cause, followed by left heart valvular regurgitations due to degenerative disease and infective endocarditis. Post-radiation valvular disease might become more frequent in the future. More recently, left heart valvular diseases were observed in the United States in patients treated by anorexigen treatment.

Adult↗

[Marfan syndrome and heart valve diseases].

Marfan syndrome is a hereditary disease of the connective tissue with increased mortality mostly due to changes of the cardiovascular system. We describe our experience with the surgical treatment of 243 patients with Marfan syndrome and cardiovascular complications. We report the results of treatment of annulo-aortal ectasia using the classical surgical methods of Bentall DeBono and Cabrol and the method for preservation of the native aortic valve and concomitant surgery of the mitral valve. Reconstruction or replacement of the mitral valve is mainly based on the classical indications. Preservation of the native aortic valve and reconstruction of the mitral valve in patients with Marfan syndrome is possible but the long-term results are still unknown.

Adolescent↗

Nitroglycerin-induced improvement in exercise tolerance and hemodynamics in patients with chronic rheumatic heart valve disease.

Nitroglycerin reduces elevated left ventricular filling and pulmonary arterial pressures in resting patients with rheumatic valve disease and reduces symptoms when given over long periods to patients with primary myocardial disease. To determine whether nitroglycerin may prove effective therapeutically in ambulatory patients with heart valve disease, its effects on hemodynamics and exercise capacity were studied in 11 severely symptomatic adults who were already receiving optimal treatment with digitalis and diuretic agents. Seven had predominant mitral valve disease, one had predominant aortic insufficiency and three had equally severe mitral and aortic valve disease. Maximal exercise capacity was assessed with graded treadmill exercise after placebo and after nitroglycerin (0.5 mg sublingually) administered in random sequence to each patient. Exercise capacity (exercise time to limiting fatigue or dyspnea) increased from a mean of 8.3 minutes after placebo to 9.8 minutes after nitroglycerin (P less than 0.005). Eight patients were studied hemodynamically during further intense treadmill exercise. Pulmonary arterial pressure was significantly lower (P less than 0.05) after nitroglycerin than after placebo (mean 44 versus 56 mm Hg), but cardiac output was greater after nitroglycerin (5.0 versus 4.6 liters/min, P less than 0.005). Thus, nitroglycerin appears to increase exericse tolerance and improve the hemodynamic response to exercise in patients with heart valve disease and may be valuable in the long-term pharmacologic therapy of such patients.

Administration, Oral↗

[Heart valve diseases].

Although valvular stenosis may be evaluated adequately by measuring transvalvular pressure gradients with Doppler echocardiography and cardiac catheterization, these methods have failed to provide reliable and accurate quantification of valvular regurgitation. In recent years the development of magnetic resonance imaging has broadened the diagnostic spectrum in cardiology, since it allows assessment of ventricular volumes without geometrical assumptions and the non-invasive quantification of blood flow within the heart and great vessels. The purpose of this overview is to evaluate "established" diagnostic tools and to show the capabilities of magnetic resonance imaging in the assessment of valvular heart disease.

Diagnostic Imaging↗

[Echocardiography in the preoperative diagnosis of acquired heart valve diseases].

With the aim of minimizing the risk and stress of an invasive diagnostics, 102 patients with acquired heart valve diseases were examined by two-dimensional echocardiography combined with pulsed Doppler technique. The results were compared with those obtained at invasive diagnostics in 91 and/or during surgery in 52 of the patients studied. In the group of operated patients the sensitivity of non-invasive diagnostics was 89.5%, specificity 97.2%; analogous data for patients not subjected to surgery were 91.8% and 93.8%, respectively. The results of the study show that in the majority of patients with acquired valvular disease a complete preoperative invasive investigation is not necessary. Only in patients over 50 years of age the intended valve replacement should be preceded by additional coronarographic examination, as in 6.8% of cases--even without kinetic disturbances at rest--a haemodynamically important stenosis was found on at least one coronary artery.

Adult↗