Questions posted in the Heart Forum have been answered by doctors from The Cleveland Clinic Foundation.

Question Title: After cardiac bypass

Forum: The Heart Forum
Topic: Heart Disease


Hello,
I am inquiring about a friend of mine in his early fifties. He has
had a quintuple (5) bypass done 7-8 years ago. It has worked very
well for him until two months ago when he started experiencing fatigue,
swelling, and often got out of breath during physical activities.
Coronary angiography revealed that only one of his grafted vessels is
blocked, with most of the blockage apparently in smaller vessels.

I have several issues to ask about:

1. His relationship with his current physician has been eroding. He
distrusts him and is unsure of his opinions. I wander how he can find
a cardiology specialist with a good reputation around Washington, D.C.
suburban area (any specific recommendations, or ways to search for
a cardiologist, at least for a second opinion, would be appreciated).

2. He is wandering if he is a good candidate for experimental
procedures currently undergoing clinical trials, namely angiogenetic
agents, and possibly transmyocardial revascularization. I am aware of
some angiogenesis gene therapy trials (CHIRON, Cornell study) and of
research done at St.Elisabeth's and Brigham and Women's Hospitals in
Boston, but am unsure of how (and if) to approach them.

Thank you very much in advance.

Daniel

___

Dear Daniel, thank you for your question. We do have new therapies for revascularization that are being investigated in clinical trials currently which include angiogenic growth factors and transmyocardial laser revascularization (TMR). VEGF is the prototype growth factor that is being evaluated now. Patients have to be evaluated at a tertiary medical center that is involved in this clinical trial and are randomized to placebo or VEGF after meeting many enrollment criteria. VEGF is infused directly into the coronary arteries and through a peripheral vein initially and then intravenously afterwards. TMR involves using a laser to create new, microscopic channels in the left ventricular walls to allow blood to "percolate" from the LV cavity to areas of ischemic heart muscle. TMR can be done surgically or via a percutaneous approach similar to angiography. TMR is also being evaluated in a clinical trial so patients are randomized to placebo or actual therapy after meeting enrollment criteria. The best cardiac center in Washington D.C. is the Washington Hospital Center and Dr. Martin Leon would be the cardiologist to contact. I'm not sure if WHC is involved in these clinical trials, but Dr. Leon could certainly evaluate your friend for a second opinion. At Cleveland Clinic, we are currently enrolling patients in both clinical trials and the contact physician would be Dr. Stephen Ellis (216-445-6712). Dr. Ellis would be happy to evaluate your friend if he is able to travel to Cleveland. I hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies.

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