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100% Occluded RCA post-Hodgkins - angioplasty or not?
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100% Occluded RCA post-Hodgkins - angioplasty or not?

I hope you can help.  I am scheduled for angioplasty this Wed (July 11) and I don't know whether to proceed or not.

BACKGROUND:
I am a 44yo female survivor of Hodgkin's lymphoma & received ABVD chemo and mantle radiation treatment back in the 1990s.

DETAILS:
After an episode of flash pulmonary edema and mild heart failure in Feb 2012, testing showed that my RCA is 100% blocked (near the top) and that the blockage has been occuring for 10 years or so.  My resting ejection fraction is 50-55 at rest and reached near-normal during my stress test.  I have decent collaterals.

I also have mitral valve regurg & prolapse. Recently I've been having increasing, significant fatigue and stable angina during many (but not all) of my 30-min. walks - pain radiates to my R shoulder and arm and ceases when I stop exercising.  My BP is low (80/60) and I have not been able to tolerate Coreg or Lisinopril.  Other than my heart disease, low thyroid and new asthma diagnosis, I am very healthy. I meditate, eat well & exercise (medium walking) 30 min. 5 or so times per week.

MY QUESTION:
I've been told that we are going to "try" to open the vessel and I am scheduled for angioplasty this Wednesday.  

I am petite and I've been told that my blockage is in a very difficult area to get to.  The blockage is also calcified.  My interventional cardiologist has an excellent reputation in my region and the procedure will be done at a major metropolitan medical center.

But I don't feel I fully understand the risks OR the necessity of trying to open up the RCA in my case.

What's are the risk/potential benefits if I proceed with angioplasty?    What happens to my heart function if we leave the RCA alone?

thank you.

Tags: angioplasty, or not, Angina, radiation, treatment decision
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This is a difficult question to answer. Without knowing the way the vessel looked, or what other testing was done to determine that the angina you have is caused by the RCA occlusion, I cannot give answers regarding the risk of the procedure. I can say that in experienced interventional cardiologist hands (someone who performs intervention to Chronic Total Occlusions, or CTOs, routinely), opening of a vessel can carry a risk of just a few percent (1-3%), which needs to be weighed against how severe your symptoms are. If your heart function is 50-55% (normal is 55-65%, though even as low as 50% would be considered low-normal) even in the setting of your recent angina, then the function would likely not change if no intervention was performed, though the intervention may not change your function either, but alleviate your symptoms.
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