Distribution of coronary artery disease in patients with isolated aortic valve disease

44 adult patients with isolated aortic valve disease underwent coronary arteriography. 70% of patients required aortic valve replacement (AVR). Of 28 men who underwent AVR, 59% of those with severe aortic stenosis, 33% of those with severe aortic regurgitation and 50% of those with mixed aortic stenosis/aortic regurgitation had associated coronary artery disease. 36% of men with aortic valve disease not requiring AVR had significant coronary artery disease (CAD). CAD was not found in the 5 female patients studied. In the patients with CAD, the left anterior descending artery was involved 84% of the time. Next in frequency were the right coronary artery, the proximal left circumflex artery, and the obtuse marginal artery. Multivessel disease was the rule. All but one patient with significant CAD had angina pectoris, but many patients with angina had normal coronary arteries. The frequent occurrence of significant CAD in adult male patients with isolated aortic valve disease argues for the performance of selective coronary arteriography in all such patients in whom AVR is a consideration.