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Preferred treatment for heart disease
My father aged 66 who had earlier underwent CABG at age of 58 (history of CAD with CABG) has again been diagnosed with tripple vessels disease. Can you pl recommend what should be right kind of treatment for him at this old age specially when CABG is already conducted on him ? Following are the results of CT coronary angiography-
LAD : Type I.Multiple mixed plaques in the proximal segment, causing near total occlusion
LCX : Mixed plaques are seen in proximal segment causing approx 75% stenosis
RCA: It shows diffuse  disease with mixed plaques in proximal and mid segment causing total occlusion in mid segment. The PDA and PLV arise from it and appear normal
left main : Normal and trifurcates into LAD,RI and LCX
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976897 tn?1379171202
I would have thought angioplasty could resolve those problems. Has medication lowered his cholesterol? I'm concerned that his disease is progressing so rapidly. Usually they
manage to get the disease slowed right down with drugs and diet. Life style changes are
also necessary, especially the reduction in stress.
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367994 tn?1304957193
RCA: It shows diffuse  disease with mixed plaques in proximal and mid segment causing total occlusion in mid segment. The PDA and PLV arise from it and appear normal
left main : Normal and trifurcates into LAD,RI and LCX.

Does the doctor consider your father ineligible for CABG or stents.  Unfortunately, many heart patients undergo interventional therapy before being effectively treated with medication for ischemia before end-stage ischemic cardiomyopathy and the interventional option no longer exists.  There is a heart transplant option for individuals under 70 due to shortage of donors.

There is Transmyocardial Laser Revascularization, it doesn't  cure CAD, but it may reduce the pain of angina and this would be for some patients with very serious heart disease or other health problems, where bypass surgery may be too dangerous. Also, some patients may have had many coronary artery bypass operations and be unable to have more bypass operations.  MLR is a type of surgery that uses a laser to make tiny channels through the heart muscle and into the lower-left chamber of the heart (the left ventricle). The left ventricle is the heart's main pumping chamber.

Of interest is your father's RCA: It shows diffuse  disease with mixed plaques in proximal and mid segment causing total occlusion in mid segment. The PDA and PLV arise from it and appear normal.  Apparently, there are collaterals (by-pass RCA total occlusion) and supplying the PDA and PLV artery segments.

For the left side the restenosis of the LAD may be stented but with mulitple lesions that option may be ruled out and that is where MLR may be an option.









Despite pharmacologic improvements, the treatment of end-stage ischemic cardiomyopathy, ineligible for coronary artery bypass grafting or percutaneous transluminal coronary angioplasty, still remains a major concern as the shortage of donors makes heart transplantation applicable only to a small percentage of patients. Transmyocardial laser revascularization (TMLR) is a new therapy for the treatment of patients with coronary artery disease refractory to standard revascularization techniques and maximal medical treatment. It creates transmural channels into the ischemic portions of the left ventricle that enable blood to perfuse them. On the other hand, using partial left ventriculectomy (PLV) as a new surgical option, as introduced by Batista and colleagues [1], consists of remodeling the left ventricular cavity by resecting a large portion of the lateral wall and thus improving function by reducing ventricular wall tension according to the law of Laplace. We report the use of a PLV as an adjunct to TMLR for treatment of end-stage ischemic cardiomyopathy with associated left ventricular dilatation.
interventricular septum and diagonal branches which supply the lateral wall of the left ventricle.

Right coronary artery (RCA) is usually the dominant artery which crosses the crux, the junction of atrioventricular and interventricular grooves posteriorly. Hence the PDA and PLV often arise from the RCA. The first two branches of the RCA are the sinus node artery and the conus artery. RCA also gives off right ventricular branches and acute marginal branches. The atrioventricular nodal artery arises from the RCA if is dominant, usually from its genu where it becomes the PDA
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976897 tn?1379171202
I dont think we need the google searches and pasting on posts, when people ask questions here it is because they dont understand those sites and hope for a laymans
explanation.

I think your Father would be wise to request a nuclear scan so it can be established which area of the Heart is deficient in Oxygen. You can have many blockages, near blockages and yet it often surprises cardiologists where the problem lies. Sometimes it
ends up being in an area not even considered as a concern.
My right coronary artery is totally blocked before the acute margin but shows no sign
of concern. My LAD was virtually blocked for many years and didn't pose a problem for
all that time. However when my LCX developed a blockage, I was on my knees waiting to die. Just one simple stent cured a LOT of pain. It could be that your Father just requires one stent but nobody knows. We could all look at the CT images for years and argue about it, what we need is the correct data, a nuclear scan.
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