ANGIOGRAM RESULTS HELP

[gemgem1]

Hello my name is Gem,

I live in New Zealand.

I have severe Hypercholesteromia and Hyperlipidemia and have had a 3-Bypass in 2002.

I am on the following medications: Lipitor, Atenanol, felodopine, asprin, femtran.

I am now quite unwell again and my life is impaired..badly..breathless all the time
And tired and pains in ankles feet and arms.

though somehow I still manage to have a sense of humor.

I would like the results of my Angiogram explained to me me "plainly"..and honestly..
I want to be able to make an informed decision as to what path to take if anything can be done to better my condition..or if not ..what the prognosis would be..

ANGIOGRAM RESULTS:

Procedure: Left Heart catheter

Access: Right Femoral artery

Catheters Used: 6 fr,JL4,JR4, Rcb,Im

Cineagios: Left and right Coronaries
Grafts

Indication: Unstable Angina

Complication: None

(though I had a major allergy to something during the procedure, which become really apparent the day after)
I was told it may have been angioderma

Left Main Artery:               Diffusely diseased - 90% distal stenosis
                                                          
LAD:                                 Diffusely diseased throughout
                                       85% proximal stenosis

Circumflex Artery:             Diffusely diseased  proximally

Intermediate has 80% proximal stenosis
First marginal has 90% proximal stenosis
Narrow circumflex, Large OM

Right Coronary Artery:       Diffusely diseased proximally mid portion
                                       80% proximal stenosis
                                       95% distal stenosis involving posterior descending branch

Very early PDA
Dominant

Pressure: Aorta 155/82 mmHg       Mean 110 mmHg

Grafts: LIMA   to  LAD
No stenosis

Arterial Graft   to   First marginal
90% osteal stenosis – 90% proximal stenosis
90% mid stenosis – 90%distal stenosis

                                                Vein graft  to  first inferior wall branch No stenosis


SUMMARY: Three vessel disease with Left main stenosis with proximal LAD stenosis
                ?? stentable main stem +/- stentable lesion in OM1.
                Severely narrowed radial graft to OM1.
                LIMA to LAD and SVG to PDA – no stenoses.

Thank you so much for your time

Gem

[gemgem1]

thanks jack
well i would love to come to america for treatment but i can pnly just afford to get it locally..damn i should of married into money!!!

I feel breathless all the time sometimes i canr even have a shower as i do not have the breth or energy..
i look after myself well eat well and healthy and stay away from stress as much as i can..

I am exhausted from walking to the letterbox..and shopping is hard too..i get swollen legs and ankles too and i too get lightheaded if I move my head quick or bend over.

Will be good to get a stent into the OM1  

I am not good in the hospital with operations and my body seems to have a reaction to all sorts of drugs and proceduers..
I don't mean to complain but that is how it is..

I need a miracle cure i have so much left to do in my life..

thanks for the input
gemgem1

[Jack54]

This is not the forum where the doctors answers questions, but is the site. Just click on forums and you will see 2 groups. The top group is the doctor's answers forum. Try posting this same question very early in the morning or earlier maybe.

You have left main disease that looks like it spread to the beginning of where your LAD and LCX ( Circumflex artery) originates, or vice versa. Either way you seem to almost have one large blockage in these 3 areas. In 2002 they did not attempt to stent the left main. Now it is done much of the time, I have read. I also have left main disease, or a plaque that extended into my proximal LAD (where it originates from the left main).

One hospital wanted to do bypass. I found another that performed rotoblational arthectomy and placed a stent in my very proximal LAD. Then I had blockages in the mid portion of my LAD. I now have 4 stents, end to end in a "kiss me" arrangement. I have a 35 - 40 % blockage that they could not get to, 3 months ago when I received the 4th stent in my very proximal LAD.

This degree of blockage has increased I think. My doctor says no more stents, so I am going to the Cleveland Clinic hospital for the MID-CAB surgery (minimally invasive) evaluation on 9/18. This surgery can only be done on an artery located on the front of the heart i,e, the LAD.

I have hyperlipidemia and/or hypercholesterolemia and cannot take statins at all.

I am disappointed to see that intravenous ultrasound (IVUS)  appears to have not been used by this cath lab. Instead of 1 dimension, IVUS gives 2 and sometimes 3 dimensions, depending on the angle.

The "draft plan" contained in the summary at the end of this report, appears to be a good start. You really need to sit down with the very best interventional cardiologist, at the very best cardiac hospital in New Zealand, and draw up the real plan. Your angiogram is on a cd and it shows what artery feeds each area of the heart. There are some redundant supplies.

You have a lot of stenting that can be done for sure. Boy if the big blockage that is in your left main, proximal LAD, and CX could be stented, and the rest of your lad could be stented, you could reattach the LIMA to another target. What a shame...I don't think you have to worry about your RCA, since your SVG to PDA  shows no stenosis.

"Arterial Graft   to   First marginal
90% osteal stenosis – 90% proximal stenosis
90% mid stenosis – 90%distal stenosis"

I think the above could be fixed by stenting of the OM1. Sometimes the 1st marginal is called the obtuse marginal 1, if you have 2. This may solve the problem with the "Severely narrowed radial graft to OM1."

"Stentable main stem" is referring to stenting your left main.

It would be good to compare your first angiogram with this one.

You have a lot of possible stenting to do. It could be done in 2 or 3 sessions. Although the summary doesn't mention a lot, but the stenting of the left main would be a very special procedure I think. None of the plaque can go toward the heart, or back through the aorta to the brain.

Could you describe in more detail how you feel now? Like can you mow the yard or do any small projects at all? It would help me so much to know, because now I can mow the yard and it might take me 2 or 3 days to recover. I have zero energy. My body aches all over, especially my legs, arms and feet. My legs are starting to hurt when I am sitting. I also get lots of swelling in my lower legs, feet and ankles. I am also getting lightheaded if I move my head quick or bend over.

Have you had normal echocardiograms and EKGs throughout your treatment?

I have other ailments such as arthritis, chronic fatigue, and fibromyalgia that I usually blame some of this on, but now I believe it is my heart. I  have been diagnosed with diastolic failure and a slightly enlarged left atrium. If you don't feel like going into this, I will certainly understand.

Welcome to the board and I will look forward on hearing of your progress. Oh yeah, don't let national pride keep you from traveling to another country for your heart repair :)

Jack

[thethinker]

You should have an intervention on that radial graft.  THey could place a stent in there eleviating your stenosis.  I wonder why you weren't told this?  I think you should ask your doctor again.

[gemgem1]

HI THERE THANKS FOR YOUR RESPONSE
I have been told by my surgeon that they will not do another bypass as it is too dangerous..i also had a second opinion on that..the dr who did my first bypass agreed!!

I will look into Zetia

thanks

is this the forum where the DRs answer questions too??

[Itschuck2c]

It sounds as if your gona need another bypass. One of your grafts from the previous bypass is plugging up, badly. The other graft is ok..plus 2 new ones that are questionable to the point of a bypass being preferred over a stent. They are 80 percent blocked. The other one that was grafted is 90 percent blocked.
If they suggest a bypass do it..also ask about zetia, its a drug that blocks cholesteral from being absorbed in the intestines...will drop your ldl even more than it is now. You take it along with the lipitor.