[Indications for coronarography in heart valve diseases].

Among 407 patients with rheumatic heart disease studied in our department, we found 8.3% with coronary atherosclerosis: 2.7% with mitral stenosis and 2.4% with aortic stenosis, lower figures than those reported in the literature. In our patients with coronary atherosclerosis, the male to female ratio was 1.6:1. The mean age of men and women with coronary atherosclerosis were 58.9 +/- 8.48 years and 60.33 +/- 5.75 years respectively. The cumulated relative frequency curve of the age was shifted to the right in the patients with coronary atherosclerosis, compared with the age frequency curve of the patients with normal coronary arteries: 50% of the cases with coronary atherosclerosis were < or = 60 years old; on the other hand, 50% of the patients with normal coronary arteries were < 53 years old. We only discovered 3 patients younger than 50 years old with coronary atherosclerosis. In order of frequency, the coronary arteries more affected were the anterior descending, right and circumflex. The mean coronary stenosis was 75.2 +/- 21.2%. Disease of one vessel was observed more frequently. We believe that age is not a good parameter to indicate coronarography in patients with valvular heart disease. If coronarography would be performed in all patients with valvular disease > or = 30 or 40 years old, would result in a great number of normal studies, with the consequent misspend of supplies and the increased risk of complications. On the other hand, restricting the coronarography indication, would miss the diagnosis in patients that might need myocardial revascularization. To restrict or to increase the indication of coronarography in patients with valvular disease will depend of the frequency between rheumatic heart disease and associated coronary atherosclerosis, and also on the atherosclerosis risk factors present in each patient. We recommend not to use the age of the patients as an index to indicate coronarography.