By-Pass Surgury

I had a  5V CABG  on 2/23/01:  LIMA-LAD, SVG to D1, OM1, OM2 & right PDA.  Not sure what all means.

I recently had a nuclear stress test with the following results:  LVEF  53%;  LV wall motion:  Hypokinetic apical;
Horizontal Long Axis:  reversible apical defect; Frequest PVC's and SOB during the Lexiscan injection.  All other finding were normal.
Can you explain the By-pass and stress test.  Does the abnormal findings on the stress test point to one of the by-pass vessals?

I am a 59 year old male with CHD and type 2 diabetes
Thanks You
Joe

[ed34]

Hi Joe, thank you for your post. First let's look at your bypass surgery. It looks as though the majority of your bypass was emphasised on the left side of your heart, i.e. the left ventricle. You had a graft onto the left anterior descending which is the main vessel feeding the left side, and this was done using an artery coming from your chest. This is a good thing because arteries do last much longer than veins. You had a vein graft to your Diagonal 1 which comes off the Left anterior descending. It looks like your Circumflex was also diseased, a major vessel which branches off from the top of your left anterior descending. Both Obtuse marginal 1 and Obtuse marginal 2 vessels were grafted with veins. You should have a lot of good feeds going on but the nuclear stress test does give a bit of concern. However, this depends on your history and what is known in your records. The only worry is the mention of hypokinetic apical. Hypo = less than normal Kinetic = movement. Apical is the very bottom of the left ventricle, where it curves around at the bottom of the heart. So, basically this is saying the very bottom of the left ventricle isn't moving as they would expect and they say it is reversible. I would suggest that they can see an insufficient oxygen supply to that area which, when intervened, would restore the function. They say reversible because the scan for your heart resting probably showed oxygen reaching the area, but the second scan under stress would have showed very little, if any, increase in blood supply to the area, causing the muscle to struggle.
I should think they would want to do an angiogram next to establish where the blockage is and how best to deal with it. Maybe they will just stent it being as you've already had so many bypass grafts already done. It looks like a new blockage rather than a problem from your existing bypass vessels. The fact that an artery has been grafted to your LAD makes me doubt if this is the problem.
I hope this helps
Take care