SIGNIFICANT CORONARY ARTERY DISEASE IN PATIENTS UNDERGOING VALVULAR REPLACEMENT OPEN HEART SURGERY

*Dr. Muhammad Aasim and Dr. Raheela

ABSTRACT

Background: Valvular heart disease is an important health issue in developing as well as developed world. In underdeveloped and developing countries the etiology of valvular heart disease is mostly rheumatic while in developed world it is mostly degenerative. Symptomatic valvular heart disease necessitates open heart surgery. Patients requiring open heart surgery for valvular disease need to be screened for concomitant coronary artery disease when indicated. Materials and Methods: This descriptive cross sectional prospective study was conducted in Department of Cardiovascular and Thoracic Surgery, Rehman Medical Institute Hayatabad, Peshawar, from 15th December 2012 to 15th January 2014 (13months). Patients admitted to RMI during the study period for elective valvular open heart surgery fulfilling the ACC/AHA guidelines-2008 criteria for screening for CAD, were subjected to coronary angiography. Luminal narrowing in a single or multiple coronary vessels (≥50% Stenosis) as detected on coronary angiography was considered as significant concomitant coronary artery disease. Results: Our study included 171 patients of valvular heart disease requiring open heart surgery. Out of the total 171 patients, 103 (60.2%) were Male and 68 (39.8%) were female. Country wise, 105 (61.4%) patients were from Pakistan while 66 (38.6%) patients were from Afghanistan. Patients’ age ranged from minimum 35 years to maximum 80 years with mean age of 51.78±10.02 years. Out of the total 171 patients coming for valvular open heart surgery, 41 (23.98%) had significant concomitant CAD. There was no case (0/26) of concomitant significant CAD in age group 35 to 40 years in both male and female populations irrespective of the presence or absence of risk factors. In age group 41 to 50 years there were 9/67 (13.43%) patients having significant concomitant CAD with valvular heart disease, 14/45 (31.11%) patients in age group 51 to 60 years had significant concomitant CAD, while 18/33 (54.55%) patients in age group more than 60 had significant concomitant CAD. This difference was statistically highly significant (P value < 0.001). Analysis of specific valvular Heart Lesions associated with significant CAD showed AS to be the most frequent 14/41(34.15%) pathology, followed by, MR 10/41(24.40%) and then combined AS&AR 06/41(14.63%). Isolated MS 3/41 (7.31%), Isolated AR 1/41(2.44%) and other lesions were much less frequent. Statistically this difference was highly significant (P value <0.001). Conclusion: At the age of 35 to 40 years in both male and female, routine screening Coronary Angiography should not be done in Pakistani and Afghani patients having VHD requiring open heart valvular surgery. In male smoker, hyperlipidemic; and in female diabetic, hypertensive or hyperlipidemic patients; the patients with AS or MR; aged 41 to 50 years coronary angiography should be performed prior to valvular open heart surgery to screen for possible CAD. In patients aged 51 to 60 years and those older than 60years, both male and female, routine coronary angiography should be performed prior to open heart valvular surgery to screen for associated significant CAD.

Keywords: Valvular Heart Disease. Coronary Angiography. Coronary Artery Disease. Open Heart Surgery.