This study was performed in order to assess the incidence of coronary artery stenosis in patients with valvular heart disease (VHD) in Korea and its correlation with coronary risk factors and to investigate the need for coronary angiography in this subgroup of patients with VHD before surgery.

Patients with rheumatic mitral VHD (n=375) and isolated aortic VHD (n=187) who underwent cardiac catheterization and coronary angiography at Seoul National University Hospital between January, 1991 and December, 2000 were enrolled in the study. Significant coronary artery stenosis on angiography was defined as stenosis of more than 50% of the luminal diameter. In each patient the presence of the following coronary risk factors were recorded:moking, diabetes mellitus, hypertension and total cholesterol concentration.

In patients with rheumatic mitral VHD, the incidence of significant coronary artery stenosis was 5.6% and was correlated significantly with age, hypertension and smoking. Significant coronary artery stenosis was not found in patients below 50 years of age. In patients with isolated aortic VHD, the incidence of significant coronary artery stenosis was 9.1% and was correlated significantly with age. Significant coronary artery stenosis was not found in patients below 45 years of age.

The incidence of coronary artery stenosis in VHD was very low and showed a general distribution in older ages in Korea. These results suggest that coronary angiography, a routine evaluation before valve surgery in younger patients who have neither risk factors nor angina pectoris, should be performed selectively in patients older than 45 years with consideration of the cost and risk of the procedure.