The value of coronary angiography is controversial. It is usually performed if the
patient is stable enough to tolerate it. The decision rests between a balance of the benefit
associated with documenting the coronary disease and the disadvantages of undertaking
angiography in a compromised patient.
I am a resident, i will give my opinion on the subject and it is in no way an expert opinion. i think patients with history of angina or ECG documented ischemia/infarct in the territory other than that of the VSR (ie anterior or posterior) , should undergo coronary angio in the settings mentioned in this question. otherwise we shouldnt subject patients to this additional procedure before surgery as many studies have shown that CABG with VSR repair doesnt affect survival.(ie Pang et al, journal of cardiothoracic surgery 2013)
Yes. Coronary angio will help to identify the culprit artery which can be grafted or stented along with VSD closure.
Coronary angiography is more useful to find if any other territory other than the VSR territory is affected because that might determine how good your myocardial protection is and might affect outcome.
I would be in favour of a quick cornary angiogram shoot with minimum dye as long as the patient is able to tolerate hemodynamically.
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