Heart Bypass good for 3 months?

Question

In Oct.2007 my 66 yr old, non smoking husband had 5 bypasses and an aortic valve replacement. Approx. 2 1/2 after surgery his cardiologist had him undergo a series of tests on his heart. At about the same time he began to have chest pain when walking which has become more servere. He also has pain when he becomes nervous or anxious which he never had before the surgery. On our follow up visit his Dr told him the tests shows a portion of his heart where there are 3 bypasses is not getting enough blood. Although we realized his recovery was going backwards we were shocked. Teh doctor feels plague is the cause of the problem. My husband resisted his suggestion of doing a cath, so he was given a prescription for Tricor 145mg. The doctor drew a diagram of the procedure that was used and in the area where there is apparently blockage a T was used to do 2 bypasses. The cardiologist seemed concerned that a stent may be difficult or impossible to place there. My questions are: 1: How can blockage occur so soon after surgery and should we expect more of the same in the near future? 2: Do we have unrealistic hopes from the Tricor? 3: Why would a technique (a T) be used which would make repair difficult or impossible?

Carol223 · Answer

Thank you for your reply. A stress test determined there was a problem.  An angiogram on 2/13 revealed 4 of 5 bypasses had shut down.  He was immediately hospitalized to keep him safe for surgery scheduled on 2/19 as his heart is now functioning on only one major artery.  Needless to say I am most anxious and wish we had more answers.  When I ask why this happened it is difficult to get a direct answer.  They are doing a great of blood tests to determine if there is a condition there that could be problem. The technique used, 2 connectors for 5 bypasses doesn't seem to be a technique that this cardiologist is impressed with. When I ask how we know this won't happen again he says a difficult technique will be used.   I feel I have to read between the lines to get the meaning of some of what he says.  I realize one professional is careful about criticism of another.  In a few hrs I will be meeting with the surgeon and I hope so very much he will say something to help lessen the anxiety.  And, of course, maybe some straight answers on just went wrong.  They have told me he has a good prognosis, but the fear doesn't leave.  Of course, it is difficult to think of him going through this again in less than 4 months time.  

Thank you again for taking the time to reply.

kenkeith · Answer

An area of blockage that is at a bifurgated location is difficult to stent  as a dilation of branch occludes (partially) the other.  I have complete blockage of the LAD and 72% of the circumflex vessel.  Graphically, it looks more like a "Y" on its side. The LAD has developed collateral vessels and a natural bypass.  Th circumflex is untreated.  Medication has been the protocol for about 4 years, and I have no problems.

Frankly, I don't understand the "T" techique, and you ask a  good question, "why?"    A blockage should not or it is not expected to occlude so quickly, if at all.  But the grafted vessel is harvested from an area that may have had some occlusion.  Unfortunately, the vessel is not clean as a whistle, and there is a limited source of choice.  Is a cath exploratory to determine if a stent can be implanted? What test determined the bypass problem?

Tricor is medication to lower cholesterol.  That wouldn't correct the current problem, but is meant more to prevent further blockage.  

Sorry for yiour husband's problem after all the surgery, etc.  Nor a very good commentary for a bypass!

Flycaster305 · Answer

I can certainly understand your husband's reluctance to have a cath procedure given the amount of surgery and hospital time he has had.  However, a cath will in all probability answer the questions that are foremost in your minds, and hopefully point to a solution.  I've had at least ten of the heart cath procedures, and they are minimally invasive, just an inconvenience.  If I were in your husband's shoes, I'd be begging for the cath procedure asap.  I don't function very well when facing a problem when I don't have any information to use to solve the problem.  I wish you both well.  Keep us informed.