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Artery Identification
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Artery Identification

  The proximal left anterior descending artery -and the- mid left anterior descending artery.  Are these one in the same artery but divided up to show specific locations of problems?  I.E. instead of saying "down two inches and to the left, you would say "X section of X artery?

  Reason I ask is that I got my surgical report today and now have a better idea of what went on and why but still have questions...  Prox.left was 70% blocked, Mid left was 80%, can I assume the reason why I got a bypass instead of two stents was because there where two blockages, one after the other in the same artery and it's far too hard to push a stent through another to take care of both?  Or am I assuming something completely wrong?

(report says....)
(1) Left Main (LM): left main artery has a mild ostial tapering.
(2) Left Anterior Descending (LAD): there is severe disease of the LAD.  The proximal left anterior descending artery has severe stenosis (70%).  The mid left anterior descending artery has severe diffuse stenosis (80%). The first LAD diagonal branch has a moderate stenosis.
(3) Circumflex (Cx): There is severe disease of the Cx.  The proximal circumflex artery has a severe discrete (<10mm) stenosis (90%).
(4) Right Coronary Artery (RCA): There is severe (occlusive) disease of the RCA.  The mid right coronary artery has a lengthy occlusion. Left-to-right colaterals from the Cx are present.

  I have many more questions but I want to hit them one at a time under their own thread.  and last, this was a 2x bypass, there are three blockages mentioned but I'm assuming it was the 80 and 90% blockages that were bypassed.  I'm still reading the report.
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367994_tn?1304957193
Proximal left is near the bifurcation of the left main into circumflex and LAD and very difficult to stent due to location.  Usually referred to as proximal, mid and distal locations as I have seen.  Your assumption could be true as well. There are collaterals from the circumflex, and that may not need a bypass.

I would assume it is the LAD and RCA that has been bypassed.  The cx has different configurations for individuals. The circumflex artery curves to the left around the heart giving rise to one or more diagonal or left marginal arteries. It helps form the posterior left ventricular branch or posterolateral artery. The circumflex artery ends at the point where it joins to form to the posterior interventricular artery in 10% of all cases.... In the other 90% of all cases the posterior interventricular artery comes out of the right coronary artery.  A bypass would need to take into consideration the current flow of blood and that includes the collaterals.  
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907968_tn?1292625804
Found it....  It's a bit hard to read, assuming it's a photocopy rather than a computer printout.

Operative Procedure
  Coronary artery bypass grafting x2 with left internal thoracic artery to the left anterior descending and (saphenous vcin 1)?)) to the obtuse marginal.

  Now I need a picture that shows these and the previous mentioned (thanks Ken) and labeled.
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976897_tn?1379171202
I think (if memory serves me correctly) the Obtuse Marginal is down the Circumflex.
Was it a triple bypass you had? Usually a surgeon will graft two bypass vessels to a LAD, not just one. Your report seems to suggest 2 vessels grafted to LAD and one to the Obtuse Marginal (which is a common area for blockages).

With regards to not using stents, the top of the LAD, after the branch of the circumflex, the vessel is slightly curved. A Doctor has to try and get a catheter through this and keep it central or your artery wall could be punctured causing a very serious situation.
It also depends on how hard the material is, tough plaque will not allow a catheter to penetrate it. It would be like you trying to push a thin wire through a lump of limescale from the bottom of a kettle.
But back to your report. I dont think the rca was bypassed. I think one vessel was grafted to the LAD just below the first blockage, another to the bottom of the LAD to bypass the second blockage and a third vessel was grafted below the blockage in the obtuse marginal.
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367994_tn?1304957193
Like fingerprints vessels are not the same configuration with individuals ,and pressure can deform, twist, etc..  The area at the junction or bifurcation of the main artery often is occluded due to blood flow turbulance and sometimes to stent the LAD can remodel the vessel and inpinch the CX.  And as the OP surmissed the LAD may not be penetrated due to blockage.

As stated, "In the other 90% of all cases the posterior interventricular artery comes out of the right coronary artery.  A bypass would need to take into consideration the current flow of blood and that includes the collaterals."  That would be a consideration whether or not stent the RCA.  

My RCA was stented to help feed the distal portion of my heart that was being feed by vessels from the left side.  Collateral development will not be the same with each individuals.

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907968_tn?1292625804
"Was it a triple bypass you had?"   I was "originally" going by the discharge papers that say I had a double.  That paper says;
Procedures/Therapy/Surgery; 4/21 CABGx2 (LIMA-LAD, SVG-OM).  That and now the surgical report, the portion in my second post.
  A second question; Unless you know better i would assume there was a video made of the angiograph so the surgeon would know specifically where to bypass(?).  Do you think that is normally saved and if so, how would I go about getting a copy of that?
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976897_tn?1379171202
Yes I had a triple. In the UK it is normal practice to graft two vessels to the LAD, never just the one. I had LIMA/SV attached to the LAD and a second SV attached to some kind of diagonal which took a CT scan to locate when it had shut down.
In the UK, angiograms are kept on live servers until the patient is considered well enough not to see a cardiologist again. They are then backed up onto cd. I am able to purchase a copy at any time and it only takes them a couple of minutes to burn it. Im not sure what format the images are in, and what software is required to view them on your PC.
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907968_tn?1292625804
  That was a quote with an answer, not a question!  I've made similar mistakes before ;-)
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907968_tn?1292625804
wish we could edit these posts because I just realized what I did.  The first part was a quote, and In thank you for the info about the UK recordings, I'll ask my cardiologist about a recording and what it takes to view it.
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