Posted By CCF Cardio MD - SK on November 16, 1997 at 23:34:45:
In Reply to: help me to understand this posted by patrick starkey on October 29, 1997 at 00:49:12:
Could you please put this in easy to understand terms:the following is from my doctor:left anterior desending has a membrane-like eccentric lesion in its proximal segment which narrows the lumen at least 70%. The distal left anterior descending fills mainly from the graft, but also receives some flow from the native vessel. The graft to the left anterior descending has significant narrowing. The circumflex is normal. the right coronary artery,which was a balanced vessel, is now totally occluded.The graft to its marginal is extremely attenuated and from a practical purpose, is not functioning.The radial artery to the marginal branch is extremely attenuated vessel.The internal mammary artery graft to the left anterior desending, which seems to have been connected distally to a segment of the radial artery(or a radial artery could have been connected to the terminal segment of the internal mammary artery)shows significant tubular narrowing.Please tell me what this all means, and what i can expect if i do not have a second surgery.
I will start from the beginning. Heart is a muscle which pumps blood in the entire body. Just like any other muscle (e.g. biceps), heart needs oxygen to live. There is a lot of blood inside the heart but it can not directly use oxygen from this blood. So, it pumps the blood to itself before sending it any where else in the body. The blood vessels that take blood to the heart are called the coronary arteries as they sit on the top of the heart like a crown.
There are two main coronary arteries, the left and right coronary artery. The left coronary artery divides in the branch that supplies the front of the heart (left anterior descending artery- LAD) and that supplies the side and back of the heart (the circumflex). The right coronary artery (RCA) supplies the bottom of the heart. In 10% of population, the right coronary artery is small and does not supply any significant part of the heart. In that case the circumflex artery (Cx) supplies bottom of the heart.
In your case you had blockage in two of the three major arteries (LAD and RCA). The bypass grafts were placed beyond the obstruction in these two arteries. From your description it is evident that one bypass (the most important one, to the LAD) is still functioning fine. The one to the RCA is not functioning. Also, it is noted that in your case the RCA is not a large vessel (balanced circulation). Thus, the heart muscle at risk is small. To date, in this kind of a situation (single vessel coronary disease), by pass surgery is not shown to improve survival. So, if you are not incapacitated with symptoms it is very reasonable to continue aggressively, the medications to control high cholesterol, blood pressure etc. without undergoing another surgery.
I hope I have answered some of your questions. We are sorry about the delay in answering the question. If you are seeking a second opinion or further evaluation, an appointment with one of our cardiologists can be arranged by calling the Cleveland Clinic at (216) 444-6697.
Information provided in the Heart Forum is intended for general medical informational purposes only. Actual diagnosis and treatment of any particular medical condition can only be made by your family physician(s).
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