Women, failed bypass, failed PTCA

  My mother is a young, petite 74 until this February when diagnosed with heart disease, due to having chest pain.  (At age 65, she had a cath that was completely clean.)  In February, she underwent triple bypass, seemed successfull, some hemorrhaging problem in recovery, but otherwise ok.  Month later, chest pain, another cath with results being two of three grafts had occluded at the site of the sutures. Occlusion was with leg veins, third being mammary artery graft was good. Suspicion was latex allergy that was not known at time of surgery.  Remedy was angioplasty of one artery, and wait and see on the third.  In late June, she developed chest pain again, third cath indicated angioplasty artery was occluded and now, mammary graft was 'pinched' at site of suture.  Remedy was angioplasty same artery again, wait and see on mammary graft.  Angioplasty was performed latex-free.  Mammary graft is estimated to be 70% to 80% blocked.  Known complications:latex allergy, abnormal fibrinogen, possible ? family history of heavy production of scar tissue, small veins.  Any advice on next step or where to seek second opinion?

[CCF Cardio MD - MTR]

Dear Patricia, thank you for your question.  Unfortunately, your mother has
had early failure of her bypass grafts and has required multiple procedures
since then for recurrent angina.  Since your mother is petite, her coronary
arteries are most likely smaller than normal which makes it more difficult
to suture in bypass grafts and to perform angioplasty.  I did an extensive search
of the medical literature and I was unable to find any association between a
latex allergy and premature bypass graft failure.  When a patient has a latex
allergy, they usually have a severe rash when exposed to latex and rarely
can become unstable when they are exposed to latex catheters intravenously.
In experimental animal models, heart attacks have been caused by ligating the
coronary artery and injecting latex directly into the artery but that is an
experimental situation that doesn't correspond to anything seen with patients.
Also, increased fibrinogen levels have been associated with an increased risk
of coronary disease in some small studies but no conclusive data is available yet.
Thus, your mother most likely had early graft failure because of technical problems
at the anastamoses (suture sites) of the bypass grafts.  Without knowing the
results of her catheterization and the size of her coronary arteries, I can't
comment about what options should be considered now.  However, if you would
like to have your mother evaluated here at Cleveland Clinic, we would be happy
to see her.  At our institution, we specialize in taking care of difficult
situations like what your mother is involved in.  Whether it would be another
angioplasty or redo bypass surgery, we may have something to offer her.  If you
want to schedule an appointment, please call 1-800-CCF-CARE and ask for an
appointment at Desk F-25 with a cardiologist who specializes in angioplasties.
If you are unable to travel to Cleveland, then I recommend that you have your
mother evaluated at the nearest tertiary academic medical center.  I can offer
you some names if you write back and let me know where you live.  I hope you
find this information useful.
Information provided in the heart forum is for general purposes only.  Specific
diagnoses and therapies can only be provided by your physician.