Bypass to where

[yager91]

My LAD is 100% blocked at the top. From cardiac cath procedure.
There is an artery coming off near the blockage that goes half way down the heart.
Probably a collaterial that developed when the LAD clogged.
There is also a small artery that comes up partway forom the bottom of the heart.
Looks like from the Cx.
Heartbeat looks normal. No scar damage.
I see a surgeon next month about doing a MIDCAB bypass. Not open heart.
I see nothing in the CATH vedios to bypass to.No diagonals.
I've never had any heart symptoms nor have any now. I get a little winded sometimes when
working in the yard or when i run.
I do have a 50 to 60% stenosis in my RCA but that is below that 70% magic number.
I have had stress test, ultrasound nuclear scan.
I am of the opinton that if it's not broke enough don't fix it.
What do I do?

[yager91]

Yes, I have 15 vedios from the catheretization. the LCA comes off the Aorta and goes to the LAD and then to the Ramus if there is one, and
then to the Circumflex.If the circumflex is dominent, the artery goes down
the back and side of the heart and curves up the front of the heart between
the ventricles.
I also looked at the RCA again.I have 4 vedios. the first one shows a
12mm blockage in the artery near the top part but still shows good flow
for the rest of the artery. The 3 other vedios do not show a blockage and
show good flow. I've flipped these veiws and used negative veiws but still
get the same results.The veiws are all the same of the RCA across the
front of the heart with a couple showing branches extending to the left
ventricle.
What do you make of it?  

[ed34]

I still can't understand what you are describing here. The circumflex goes to the back left. The lad to the front. Do you have the images?

[yager91]

Hi again. The main artery from the aorta goes 1st to the blockage at the LAD, At this point another artery goes half way down the heart between
the 2 ventricles( comes out right under the blockage.
The aorta artery then goes on to the circomflex to 3 other arteries. 1 may
be a Ramus, then another artery then the Cx. the Cx has a curved protion
at the bottom that curves up to between the 2 ventricales but not quite
high enough to meet artery coming down from the blockage at the aorta
artery and the LAD. This is a thin artery.
What I think is the collateral artery is good size but not as wide as the
LAD would be and splits into several branches at the bottom.
I couldn't see any arties coming from the RCA.If I were a surgeon,I'd consider routing the Mammary artery to the collateral before it branches
and also run it to Cx where it curves between the ventricles.
What do you think? I've done a lot of plumbing.

[ed34]

"There is an artery coming off near the blockage that goes half way down the heart."
I think THIS is your Left Circumflex. Where your Left main stem comes off the Aorta, there is a bifurcation (branch). One is the Left Anterior Descending, the other is your Left Circumflex.
Before considering any options, I think what you need to do is collate the details of your artery configuration. You say your LCX looks quite short, like if goes halfway down the heart? but the LCX is at the rear left side and would normally go further down unless maybe you are right dominant.
I would establish (even if it means sitting with your cardiologist), where your collaterals are coming from for the LAD. If they are coming from your RCA, then you know this is already 60% blocked. If it goes above 70%, then it's highly possible those collaterals will lose pressure and close up. If they are coming from the LCX you also have to make sure you have any blockages treated asap if associated with symptoms. The thing to remember is that your LAD has no natural feed of its own anymore, either your LCX or RCA is feeding it. If that source vessel becomes low enough in flow, then the LAD will also be affected. So as soon as (if it happens) you get any form of angina on exertion, get to a cardiologist because you want to save those collaterals. It is likely that the treatment would just require a stent. Personally, I wouldn't go for the bypass option. My LAD was blocked 100% 4 years ago, and a triple bypass lasted me just 3 months.

[yager91]

Thanks.
Three cardologists have recommended a bypass but they all seem to
look at the blockage and stop there without mentioning the collaterials
or why I'm still walking around.

[jrbon]

If you have no symptoms, I would agree with you.

Jesus