Aa
Aa
A
A
A
Close
Avatar universal

Angiography And Bypass surgery. Please help

Hi. my father who is 67, recently had severe chest pain for a whole day. Angiography was done, and the doctors suggested a bypass. Can the professionals here have a look and tell me what the report says in simple english language? Thankyou.

                                        Coronary Arteriography and Left Heart Catherterization

(due to a picture report, the first paragraph is faint. I have tried my best to copy as it is.. a few words might not be right, but the bottom report is all as is).

Left heart catheterization was performed by perculaneous technique through the Right Radial Artery using a 6F Antenna sheath under local anasthesia. Coronary Arteriography was performed by Judkins technique sing #3.5 judkins left and right 6F coronary catheters. LV angiogram was done with JR 4.0 6F catheter. Non ionic contrast media was used. Peripheral pulses of the right had at the end of the procedure were normal. The patient tolerated procedures well.

PRESSURES:
Pre Angli         AO= 125/80-100       LV=125         EDP=12

CORONARY ARTERIOGRAPHY:

Left Coronary Artery:
Left Main Stem:
- Bifurcating vessel with mild to moderate diffuse disease.

Left Anterior Descending Artery:
- Good sized vessel with long segment of severe proximal disease followed by severe disease in apical part of LAD

Left Circumflex Artery:
- Good sized, co-dominant vessel with severe proximal and mid disease. First obtuse marginal branch is a sizeable vessel with sub total ostial occlusion. Second obtuse marginal branch is a fair sized vessel with severe proximal disease.

Right Coronary Artery:
- Co-dominant diffusely diseased vessel with moderate proximal disease followed by severe disease in mid and distal parts

LV Angiogram:
- Mild to moderate LV systolic dysfunction
- Ejection Fraction=40%

Conclusion:
- Severe three vessel disease
- Mild to moderate LV systolic dysfuction

Management Decision:
- Coronary Artery Bypass Surgery


Any help will be appreciated. Thankyou.
2 Responses
Sort by: Helpful Oldest Newest
Avatar universal
Thank you very much for the detailed reply. your help is very much appreciated. Thanks
Helpful - 0
976897 tn?1379167602
No professionals here, sorry, but based on your report we can offer our personal opinions. Firstly I don't know how much you know about the coronary arteries? The Left main stem (left coronary artery) comes off the largest artery in the body, the Aorta. The left main stem then divides into 2 vessels, the left circumflex (left side and rear of heart) and the left anterior descending (left and front of heart). The circumflex has vessels branching off called marginals, the left anterior descending has branches called diagonals. So looking at these in your report. The left main stem which feeds everything on the left side has moderate disease. This is obviously a very important vessel because without it, we would die. There are 2 choices here. Firstly, leave it and hope that lifestyle changes deal with this disease and prevent it getting any worse. Secondly, get a new blood supply to the left side of the heart, using the Left internal Mammary artery which runs across the chest. We have 2 of those, so we can spare one. This could be cut one end, then attached somewhere on the left side to give a better supply. Now we travel along to the left anterior descending. This is a badly diseased vessel. The disease is severe and in two locations, the top and the bottom. If the top blocks off totally, then a serious heart attack will occur. So the middle of this vessel will likely be a good place to graft the left internal mammary artery from the chest. It doesn't mention the condition of the diagonal branches so I assume these are clear. Now, we go down the left circumflex. This vessel is in a bit of a mess. It has severe disease at the top and half way down. The two main branches from this also have severe disease at their beginning. This would mean that bypass is a bit trickier. A graft to the circumflex is needed and a graft to the mid section of each marginal.
Now we move over to the right side of the heart and the right coronary artery. This artery is badly diseased in the middle and the bottom. I have no idea what they can do here apart from graft to an area between the disease. This could be done using the right internal mammary artery from the chest. Believe me, stenting is definitely not an option here. The amount of work required would create a lot of risk and it is likely some stents would block up again anyway. One word of advice I would give, ask the cardiologist to check two things before any decisions for surgery are made. First ask if he believes a nuclear scan would be beneficial. This would show exactly where the blood supply is weak and needs the most attention. He may have opened some natural bypasses (collaterals) to help get around the disease and a nuclear scan would show this. Secondly ask about chest infection. The biggest cause for recovery problems is infection. This can already be in the chest or lungs and the traumatic surgery allows it to take over and cause all kinds of issues. I wonder if some antibiotics might be wise before surgery. On a last note, I know how scary the idea of bypass surgery is and we all look for alternatives. I've had the surgery, so I know. However, the theatre room has the best equipment for the job and if something does go wrong, the patient can be put onto bypass while the issue is resolved. If something goes wrong with stenting and serious bleeding occurs due to a ruptured vessel, then the patient has a long trip to the operating room, waiting for surgeons to prep, and the equipment to be made ready. While thinking about all this, your Father needs to think about some serious lifestyle changes to help slow or stop the disease. Healthy diet, no smoking, low emotional stress, some exercise (even gentle walking), taking the right medications. He will need mental as well as physical support after such surgery, and we are all here to support you as much as possible. If you have any questions at all, don't hesitate to ask.
Helpful - 0
Have an Answer?

You are reading content posted in the Heart Disease Community

Top Heart Disease Answerers
159619 tn?1707018272
Salt Lake City, UT
11548417 tn?1506080564
Netherlands
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
Is a low-fat diet really that heart healthy after all? James D. Nicolantonio, PharmD, urges us to reconsider decades-long dietary guidelines.
Can depression and anxiety cause heart disease? Get the facts in this Missouri Medicine report.
Fish oil, folic acid, vitamin C. Find out if these supplements are heart-healthy or overhyped.
Learn what happens before, during and after a heart attack occurs.
What are the pros and cons of taking fish oil for heart health? Find out in this article from Missouri Medicine.
How to lower your heart attack risk.