[Distribution of significant coronary lesions in patients with rheumatic valvular heart disease. Study of 300 consecutive cases (author's transl)].

Associated coronary atherosclerosis in patients with rheumatic valvular heart disease is an important finding under prognostic and therapeutic viewpoints. Selective coronary angiography was carried out in 300 patients with rheumatic valvular disease (157 cases with associated mitral and aortic lesions; 57 cases with aortic regkurgitation; 35 cases with aortic stenosis; 31 cases with mitral stenosis, and 20 cases with mitral regurgitation). Significant coronary atherosclerosis occurs in 11 percent of all patients. The distribution of the lesions was as follows: anterior descending artery (56 percent); right coronary artery (47 percent); circumflex artery (28 percent); marginal artery (22 percent); oblique branches (19 percent), and common left trunk (3 percent). Lesions in the common left trunk were only present in association with aortic regurgitation. Fourty-four percent of patients with significant atherosclerosis showed multiple lesions, and there was a distal coronary tree appropriated to coronary bypass in 78 percent of the cases. The distribution of significant coronary lesions in patients with rheumatic valvular heart disease is similar to that observed in patients with ischemic heart disease. The frequent finding, however, of a short common left trunk and/or a left coronary prevalence in patients with aortic lesions is stressed under diagnostic and therapeutic viewpoints.