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Heart Disease (Expert Forum)
Artery Blockages after CABG
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Artery Blockages after CABG
by Dharmlabh, Dec 27, 2003 12:00AM
Hi,
My father, aged 71 years, underwent CABG (OPCAB => LIMA-LAD, SVG-OM1, PDA) in April 2003. In September 2003, he complained of breathlessness while climbings stairs or walking continuously for more that 5 mnts. On colsulting the Drs, he was suggested to undergo Thallium Stress Test which concluded-"Stress Slices show perfusion defect in anterior, apical, lateral and inferior wall which show significant improvement in rest slices. Study suggestive of exercise induced reversible ischaemia in anterior, apical, lateral and inferior wall at low workload". Parameters of Stress Test- BRUCE/METS 5.29, Exercise Time - 3.38 Minutes.
After this, he was suggested to undergo Coronary Angiography. Results of this were: "SVG1 to OM1 shows 100% Ostial Stenosis. Left Renal Artery shows 30% Proximal Stenosis".
My father is diabetic which is under control by medicines. He also suffers from Prostrate problem, but that is under control by medicine. His diet is completely under control since Feb 2003.
Would like to know -
1. Is it possible for the graft to get blocked so early after CABG ?
2. What should we do now to prevent further deterioratoin is his health ?
3. What should be the next course of action ?
Thanks and Regards,
Alok.
My father, aged 71 years, underwent CABG (OPCAB => LIMA-LAD, SVG-OM1, PDA) in April 2003. In September 2003, he complained of breathlessness while climbings stairs or walking continuously for more that 5 mnts. On colsulting the Drs, he was suggested to undergo Thallium Stress Test which concluded-"Stress Slices show perfusion defect in anterior, apical, lateral and inferior wall which show significant improvement in rest slices. Study suggestive of exercise induced reversible ischaemia in anterior, apical, lateral and inferior wall at low workload". Parameters of Stress Test- BRUCE/METS 5.29, Exercise Time - 3.38 Minutes.
After this, he was suggested to undergo Coronary Angiography. Results of this were: "SVG1 to OM1 shows 100% Ostial Stenosis. Left Renal Artery shows 30% Proximal Stenosis".
My father is diabetic which is under control by medicines. He also suffers from Prostrate problem, but that is under control by medicine. His diet is completely under control since Feb 2003.
Would like to know -
1. Is it possible for the graft to get blocked so early after CABG ?
2. What should we do now to prevent further deterioratoin is his health ?
3. What should be the next course of action ?
Thanks and Regards,
Alok.
Doctor's Answer
by CCF-M.D.-RCJ, Dec 27, 2003 12:00AM
Alok,
Thanks for the post.
Q1:"Is it possible for the graft to get blocked so early after CABG ?"
Yes, particularly in diabetic patients, and particularly in the vein grafts. Rough estimates are 10% occlusion per year for the SVG. If occlusions occur in the first 6 months, technical surgical details are more likely to have contributed.
Q2:" What should we do now to prevent further deterioratoin is his health ?"
AGGRESSIVE Diet therapy, exercise, AGGRESSIVE diabetic therapy, lipid-lowering agents, and prayer.
Q3:"What should be the next course of action ?"
Two things concern me about the story you gave. One is why ischemia was seen in the anterior distribution. The LIMA graft to the LAD should be supplying blood to this area, and yet you don't mention any blockage in the LIMA graft. So either the Thallium test was wrong, the LIMA was inserted prior to the blockage and thus did not "bypass it", or the cath was misinterpreted and a blockage is present in the LIMA graft. The second thing that bothered me was your father's terrible exercise capacity. He either is suffering from severe angina, or is terribly out-of-shape.
I would consider referral to a large center for interpretation of the studies, and possible repeat of the cath.
Hope that helps, and happy holidays.
Thanks for the post.
Q1:"Is it possible for the graft to get blocked so early after CABG ?"
Yes, particularly in diabetic patients, and particularly in the vein grafts. Rough estimates are 10% occlusion per year for the SVG. If occlusions occur in the first 6 months, technical surgical details are more likely to have contributed.
Q2:" What should we do now to prevent further deterioratoin is his health ?"
AGGRESSIVE Diet therapy, exercise, AGGRESSIVE diabetic therapy, lipid-lowering agents, and prayer.
Q3:"What should be the next course of action ?"
Two things concern me about the story you gave. One is why ischemia was seen in the anterior distribution. The LIMA graft to the LAD should be supplying blood to this area, and yet you don't mention any blockage in the LIMA graft. So either the Thallium test was wrong, the LIMA was inserted prior to the blockage and thus did not "bypass it", or the cath was misinterpreted and a blockage is present in the LIMA graft. The second thing that bothered me was your father's terrible exercise capacity. He either is suffering from severe angina, or is terribly out-of-shape.
I would consider referral to a large center for interpretation of the studies, and possible repeat of the cath.
Hope that helps, and happy holidays.
Thanks Dr. for the time that you spent on the case posted by me.
Am grateful to you for this.
Answers to your questions -
1. My father is aged 71 yrs, height is 5ft 8 inches and weight is 80 Kgs. He is not able to exercise much.
2. Drs here did not mention abt severe angina.
Drs here have prescribed these medicines also - - Clavix 75 Mg, Zosta 10 Mg, Zetpril 2Mg and Folvite 5 Mg daily. They are not in favor of another surgery. Rather have hinted Angioplasty.
I am very concerned on all this. Not sure on how do we proceed.
Regards.