Bypass Operation

[Atif_Shah]

My mothere is 56.years old and her weight is 82 KG...Angiography report and CT.Angiogram report is given below....
i) Kindly analyze the report and give me your openion and suggestion.
ii)Tell me that how much discese is serve.
ii)And also the solution, dangers and possiblity

1) ANGIOGRAPHY REPORT:
--------------------------------

CORONARY ARTERIOGRAPHY:

Left Coronary Artery:
Left Main Stem: Normal Bifurcating vessel
Left Anterior Descending Artery:
                 Tight proximal stenosis followed by total mid occlusion. Distal vessel not visualized.

Left Circumflex Artery:
                 Mild generalized diffuse disease.

Right Coronary Artery:
               Dominant vessel with total proximal occlusion. Distal vessel fills retrogradely from left system.

LV ANGIOGRAM:
• Not done.
• To be accessed on Echo


Note: Also remember my mother in your prayers.

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2) CT ANGIOGRAM REPORT:
-----------------------------------------

Scan Protocols:
----------------------

Acquisition          64 x .625 helical 0.35sec          Beta Blocker     Mepressor 100 mg PO 10 mg iv     Left Main
Kv         120                                             Gating Artifact:      No                                           LAD
mA          Modulated                           Breathing Artifact:   No                                           LCX
Contrast          50ml                                             Study Quality:     Diagnostic                         RCA
HR          68min                           Complication:     None                                           Rl
Wt/Ht          82kg/143cm                           Risk Factor     HTN; Hyperlipidemia;FH       Total
ECG

Left Main Stem:
• Normal bifurcating vessel.

Left Anterior Descending Artery:
• Tight proximal stenosis with total occlusion after diagonal branch. Dista LAD is normal but ends short of apex. A fair sized diagonal branch shows generalized diffuse disease.

Left Circumflex Artery:
• Moderate proximal stenosis with mild distal disease. Obtuse marginal branches show mild irregularities.

Right Coronary Artery:
• Dominant vessel with total mid occlusion. Distal vessel shows generalized diffuse disease.

LV Angiogram:
• EDV = 110ml
• ESV =34ml
• Ejection Fraction= 69%

CONCLUSION:
 Three vessel coronary artery disease.
 Good LV systolic function.

[ed34]

EECP is a treatment where cuffs are placed on the thighs and inflation of them is timed with your heartbeat. Each time your heart compresses to eject blood, the cuffs squeeze, restricting flow into the legs. This increases blood pressure in the coronary arteries and seems to entice collateral (natural bypass) vessels to open up. It is a relatively new procedure and seems quite promising in many cases. Most patients have reported feeling much better.

[bob12345663]

Thankyou very for much for your help , i really appreciate that you replied even as though it didnt help Thanks!

[ed34]

Apart from more stents, not really. Have they mentioned EECP?

[bob12345663]

i went in for my planned pressure wire study to the right coronary artery +/- PCI to LAD. I am clearly symptomatic  with angina that limits my daily activities, mainly during cold weather. My Doctor has said, 'prior to any intervention procedure, i elected to repeat his coronary angiography in order to assess his previously deployed stent. the stent was patent with only a mild disease in the mid and distal left anterior artery. However my LAD has now become occluded. it appears to have been occluded for a few months', i.e.: chronic total occlusion. The occlusion point is just after the first diagonal branch with some proof, poor antegrade filling, probably via bridging collateral's. This allowed us to see the second diagonal branch that appears to have rather significant disease in the proximal segment. The disease in the right coronary artery also seems to have progressed since his last PCI. I decided not to proceed with any interventional treatment and to seek a surgical opinion' My doctor has said that CABG would be favourable, i was wondering if there is anything else i can do instead of CABG

[erijon]

Ed won't answer so I'll answer for him. Yes, he has the proper background and training to answer this question. He has been a great resource for many here. If you don't care to contribute, please don't use these threads to disrupt the forum.

[louietheliger]

I'm curious.  What is your medical background, if any?  Are you qualified to give advise?

Cheers.

[ed34]

I must admit I find this a bit confusing. The report says that the left artery is blocked in the middle section  and the rest of the vessel is not showing up on the Angio scanner. This is because the vessel is dry after the blockage. I would expect someone to have a lot of symptoms from this, because there are no collaterals forming a natural bypass into the bottom of the left artery. I am also surprised to see comments like "good lv function" and "ef 69%". 69% is pretty damn good. The right artery is blocked however the angiogram and CT angiogram contradict each other. One says the blockage is at the top, the other says the blockage is in the middle. Personally, I would believe the angiography report because this has seen retrograde filling and it makes more sense. Your right artery then is blocked near the top, but the vessel is being fed by natural bypasses from the left side. The right artery is dominant, and I can't imagine it getting blood from the left artery, because this is dry after the mid section. I would have to conclude the feed is coming from the circumflex.
These reports are causing some issues which, if I were the patient, would want answers to. I think an echo is needed and definitely a nuclear scan. I say this because I would want to know about the muscle condition down at the front apex section, where the bottom of the LAD is dry.
From there I would look at 2 possible options. First of all the circumflex needs to be as free of disease as possible because this is feeding the right side. If the blockages in the circumflex get worse, then blood will be less available for both the right side of the heart and the left side/rear. I would look into the possibilities of having the blockage in the right artery opened using stents also. If the muscle near the left apex is viable, then I would probably be looking to bypass.A nuclear scan would be very valuable here.