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

Question Title: Accuracy of Thallium stress test on post by-pass surgeries

Forum: The Heart Forum
Topic: Heart Disease


12 yrs ago at age 38 I suffered my ist MI. After 2 attempts at angioplasty, I underwent a triple by pass. Within a matter of 2 or 3 years, the graphs closed, all except the LAD (Thankfully). I have been living a relatively normal life style experiencing Angina only when pushed physically. I am amazed at how normal things seem, even though only one artery remains open. There is, it appears, upon subsequent catherizations, a collateral artery system which has developed feeding the right side of the heart. My cardiologist feels that there is no need for additional surgery at this time, however, there is the ever present mental stress of not knowing if the LAD will fail. Thallium stress tests are performed annually and so far, there has been no change in the results over the last 5 or 6 years. Are there any new procedures which could assist someone like me.

Dear Francis, thank you for your question. I suspect that you have an internal mammary arterial graft supplying the LAD. These grafts have excellent long-term durability, so if you do have this type of graft to the LAD and it has been shown to be patent, then there is only a small chance this graft will develop problems. Additionally, the LAD supplies collaterals to the right coronary artery which should limit ischemia in this territory. Thallium stress tests are probably the best way to monitor your situation since they are easily comparable year after year and since other stress tests (echocardiograms) would not localize potential areas of ischemia as well as thallium tests would. I can't answer the question about whether you should be considered for redo coronary artery bypass surgery, but if you would like to be evaluated here at the Cleveland Clinic, then please follow the instructions below.


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