LAD blockage

[joeblow]

I have been researching my condition in several books and through on-line information and I had a couple of questions come up that perhaps someone can help with.

Can you assume that a mid LAD blockage with a 100% occluded D1 & D2 to be, more or less, equivalent to having a proximal LAD blockage ? Their seems to be a lot written about proximal LAD blockages that would be important to know if the above were true.

What would be the key factors to indicate a repeat bypass assuming no angina but many blockages and sever ischemia ?

Thanks

[CCF-M.D.-RCJ]

joeblow,

Thank you for the interesting questions.

The answer to your first question is: "it depends".  I think that a mid-LAD occlusion with D1 and D2 blockages could most often be considered as a prox-LAD-equivalent lesion.  The one caveat would be the size and location of the septal perforators.  If a person had a large septal perforator system that arose prior to the mid-LAD lesion, then I do not think the mid-LAD + D1 & D2 blockages would be equivalent to a prox-LAD lesion.

The key factors in deciding on bypass are (1) mortality benefit and (2) quality of life benefit.  For a FIRST time operation, most cardiologists agree that the following lesions derive mortality benefit in patients with stable angina:
1. Left main (LM) significant obstruction
2. LM equivalent: prox LAD and prox circumflex
3. 3 vessel disease and low ejection fraction
4. 2 vessel disease with prox LAD stenosis and either low Ef or ischemia on noninvasive testing
5. 1 OR 2 vessel disease with high-risk criteria on non-invasive testing
6. prox LAD lesion with low EF or ischemia on noninvasive testing
7. 1 or 2 vessel disease withlow EF or ischemia on noninvasive testing

For a redo operation,  the two basic indications for bypass are disabling angina or bypassable vessels with a large area of ischemia on noninvasive testing.

Many other factors need to be considered prior to deciding on CABG, including age of the patient, their symptoms, their overall health, their expectations, etc.  The bottom-line is that you need consultation with an experienced cardiologist to help you sort through the data.

Hope that helps, and Good luck.

[Tonyc]

I am a 35yo Male, about 1 1/2yrs ago, I was diagnosed with Myocardial Bridging. I am very symtomatic and have pains daily. My Cardiologist is treating me with Atenenol,Norvasc,Imdur,aspirin,nitroquick,pamelor. Even with these meds I'm still having pain, along with the effects from my blood pressure being low (85/50) due to the meds, We have ran gastro tests, In which have came back in the normal ranges. Bypass according to my doctor could be possible but he is concerned because where the LAD comes back out from the heart the artery is so narrow thus scar tissue could cause blockage, my question on that is why couldn't a stent be put in place under the location of the reattached artery thus not allowing the scar tissue to create a blockage. Is this possible? or is there anything else that can be done, I can't keep going on like this it affects my everyday living. In closing any Recommendation of a Doctor who has a background in treating this condition..  I've lost confidence in my current Doctor.. Please Help..  

Thank you,
Tonyc