Cardiology Department, APHP and University Paris, Bichat Hospital, Paris, France.
Heart. 2010 May;96(9):696-700. doi: 10.1136/hrt.2009.183772.
Preoperative coronary angiography (CA) is recommended in patients with acute aortic valve infective endocarditis (AV-IE) and high cardiovascular risk profile but the level of evidence is low and its potential interest may be counterbalanced by the risk of dislodgement of vegetations and contrast-induced nephropathy.
To review the use, indications and complication of preoperative CA in patients with AV-IE. Design Retrospective study.
Consecutive series of 83 patients operated on for AV-IE between January 2002 and March 2007.
CA was performed in 36 (43%) patients, all but one as a preoperative test. Significant (>or=70%) lesions were observed in 10 patients and six underwent an associated coronary artery bypass graft. 47 patients were operated on without preoperative CA because of young age in 16 or recent CA in 13. Despite being theoretically indicated in all but one of the 18 remaining patients, CA was not performed because surgery as judged too urgent (eight patients) or valvular lesions were estimated as too important (10 patients). While the 35 patients with preoperative CA tended to be healthier (longer time to surgery and lower rate of urgent surgery), anatomical lesions were not different (rate of severe regurgitation, periannular complications and vegetation size, all p>0.20). No embolic event occurred after CA and preoperative CA was not associated with increased in-hospital mortality (p=0.80) or worsening renal function (p=0.93).
Preoperative CA can be performed at low risk in selected patients with AV-IE and should be considered before surgery in patients with cardiovascular risk factors. Our results support current guidelines.
对于急性主动脉瓣感染性心内膜炎（AV-IE）合并高心血管风险患者，建议行术前冠状动脉造影（CA）检查，但目前证据级别较低，其潜在益处可能会被赘生物脱落和造影剂肾病的风险所抵消。
回顾 AV-IE 患者行术前 CA 的使用、适应证和并发症。设计：回顾性研究。
2002 年 1 月至 2007 年 3 月连续 83 例行 AV-IE 手术的患者。
36 例（43%）患者行 CA，均为术前检查。10 例患者发现有显著（>70%）病变，其中 6 例行冠状动脉旁路移植术。因年龄<16 岁（16 例）或近期行 CA（13 例），47 例患者未行术前 CA。尽管理论上 18 例患者均应行 CA，但由于手术紧急（8 例）或瓣叶病变严重（10 例）而未行 CA。虽然行术前 CA 的 35 例患者身体状况较好（手术时间较长，急诊手术率较低），但解剖病变无差异（严重反流率、瓣周并发症和赘生物大小，均 P>0.20）。CA 后未发生栓塞事件，术前 CA 也与住院死亡率增加（P=0.80）或肾功能恶化（P=0.93）无关。
在选择的 AV-IE 患者中，术前 CA 可安全进行，对于有心血管危险因素的患者，应在手术前考虑行 CA。我们的结果支持目前的指南。
