الفهرس 
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Abstract
This study aimed to : The present study aimed to evaluate the association between coronary artery disease and rheumatic valvular heart disease, identify the angiographic morphological pattern, extension and severity of coronary lesions among patients with rheumatic valvular heart disease and evaluate the proper indication and time for coronary angiography to patients with rheumatic heart disease prior to their valve surgery. The present study included 210 patients selected from patients with severe valvular cardiac lesions planned for open heart surgery and refered for preoperative coronary angiography. The studied patients comprised 183 patients with rheumatic valvular heart disease (96 males and 87 females) and 27 patients with non rheumatic valvular heart disease (18 males and 9 females). The 183 rheumatic patients were furtherly divided into different subgroups according to: i) The type of valvular affection {before MVR subgroup (n = 111 patients), before AVR subgroup (n = 25 patients) and before DVR subgroup (n = 44 patients)} and ii) Coronary affection {normal coronary subgroup (n = 151 patients) and abnormal coronary subgroup (n=32 patients; 20 patients with coronary ectasia and 12 patients with coronary stenosis). The incidence of angiographically proven CAD in rheumatic valvular diseases was 17.5% of which coronary ectasia was more prevalent than coronary stenosis and in non rheumatic valvular diseases was 29.6%. The low prevalence in rheumatic patients could be due to the demographic and clinical characteristics of this population. In a group with predominantly young individuals of the female sex, and thus, with fewer comorbidities, it is reasonable to assume that the prevalence of the disease is lower than in another group, with predominantly older individuals of the male sex. In the rheumatic patients, the prevalence of the coronary artery disease increased with age, which is expected, as the comorbidities increase with age. Anginal pain and risk factors were predominantly concentrated in the group with coronary artery disease. The incidence of angiographically proven CAD in rheumatic valvular diseases was 17.5% with more prevalence in age group ≥ 50 years. The incidence of CAD in rheumatic patients among the age group < 50 years was strongly associated with high clinical suspicion regarding anginal pain and risk factors. The angiographic pattern of coronary artery stenosis appear more or less the same as among Rheumatic and non-Rheumatic patients. Coronary ectasia was more prevalent than coronary stenosis in rheumatic valve group. Carotid IMT and BAR test are good non invasive tools for early prediction of associated CAD among patients with rheumatic valvular heart disease.