Triple Vessel Disease,Require advise regarding the proper treatment/surgery of this disease

[imran7304]

My father's(70 years age,Hb level 11.9) Angiography showed : Triple vessel Disease
1- Significant stenosis of ostium of the proximal left anterior descending coronary artery(more than 20mm arterylong ,high grade (70-90%)
2-significant stenosis of the ostium of the proximal circumflex coronary artery.(10-20mm ,70-90%) (Type B2 stenosis)
3-Oclusion(10-20mm) of the proximal right coronary artery.

He is currently admitted in hospital due to intervals of chest pain diabetes level 8-9 , had chlostomy major operation 10 years back, receiving medical therapy clopedrgal,asprin,betablockers,rcvd also inj.heparin,

Docs suggested Bypass (not the open heart surgery) there in Kuwait,He opted to get his treatment from Pakistan due to lack of competent docs in Kuwait.
Question is that is it safe for him to travel by air to Pakistan.What is the better treatment of him to carry on? , Is the age factor problem for him?,although he has better will power for surgery.

[CCF HeartMD-1]

It does sound like he needs bypass surgery with 3-vessel coronary artery disease.  There are times we choose stents over bypass surgery but this is in the case of people who are very high-risk for surgery which at this point it does not sounds like he is too high risk.  Factors that make someone high-risk include age, lung disease, morbid obesity.  Also, stents are not as good as bypass surgery in the diabetic population when you have this much coronary artery disease (meaning 3-vessels involved).  I think his age is not much of a problem for bypass surgery currently.

If your father has had a heart attack in this setting or is still continuing to have chest pain, then I would be very nervous about taking him out of the hospital and flying him to Pakistan.  If he is now stable without chest pain on medications then he probably would be ok but I would check with his doctors because they are ultimately the ones who are seeing him now and know his exact situation.  

[imran7304]

Dear Doc

First of all Thanks a lot for your guidence , your opinion helped me alot and kept me encouraged for sticking to the CABG Decision.
My father flew back to Pakistan after permission from doctors in Kuwait, and had CABG on 10th Mar,2011(1st Graft LAd(mid) Lima , 2nd Graft OM1 Sapheneious Vein(Long) , 3rd Graft Rca(distal) Saphenus(Long))  . Now he is back to home after declared stable with following medication; Tab  Loprin 150 mg, Tab Carveda(Carvedilol) 6.25mg ,tab Minidiab(gllpzide) ,Cap Prozac(Fluoxetine) 20mg ,Tab Zocor (Simvastatin) 20mg    ,Tab Neurobeuon (Vit B1+B6+B12).  Thank God he is recovering speedily with no major problem yet,except 1-2 symptoms .First his B.p went to 143/80 for few times but its now on the limit of 118/75 without any additional edication .Secondly his feet/legs /feet fingers are getting swollen (looking edima type to me)  for last 5-6 days first the left one and now the right one.
My Question is that :
1-whether i should add some low dose of lopressor after consultaion for High  B.P(of this limit of B.p is high in your opinion) ?
2-Whether his swelling of feet /legs is alarming , and what i should do for this,whethr its linked with the Lesft pleural drain used shortly during his itc stay .?
3-Now after the Cabg , whether i should still keep in touch with the Cardiac Surgeon (as the post operative consultation in Silamabad hospital is on 18th April) , or i should now divert to Cardiologist(Physian) /MD for his post CABG Care.

Rgds

[CCF HeartMD-1]

Unless he has serious lung disease, or carotid artery disease (with a history of a stroke in the past), I think he should do fine on pump.  I would go with what is more common there if you are any bit concerned.  

[imran7304]

Dear Doctor
Thanks for your prompt answer, yes thats why docs there have not permitted even to be discharged from Hospital.He has an appointment from senior heart surgeon on 20th Jan, after that they will finalize the proceedings.
In the recent scenario , he is patient of Diabetics,Hypertension,Gal Bladder swollen 1 year back but got beeter with medication(not yet operated as till now is not creating further problems), Had 2 major chlostomy operations in Kuwait 11 years bac, what do you suggest what be the better option:
Conventional Byss Surgery (with Lung machine)
Beating Heart Surgery (off Pump)

More commen here is the first one , although i heard that now some surgeons are operating with beating heart here .
Thanks