bypass surgery

[yager91]

From cardiac catherization procedure:
LAD 100% stenosis,15mm. LAD pass blockage does not show any of artery.
RCA shows 60% stenosis.10mm.
No heart problem symtoms.I can do everything that I normaly do .Cut grass etc. except walk long distance.
May have PAD.
My cardiac surgeon thinks the LAD is still viable and wants to do a bypass to the LAD and come back later
for someone else to put a stent in RCA.
Since my heart is getting what it needs now, I would think that the RCA should be taken care of first in case
my heart is getting the blood it needs from the RCA. From cath, RCA is dominent and feeding the PDA.
Surgeons office just called me. Said I could get stent now, no problem. bypass is scheduled for Nov. 3.
OK. If everything is fine now and I get stent, do I really need the bypass?

[ed34]

"He told me that if you're having work done on your car you want to have the complete job done"
At least a mechanic gives a guarantee. So his analogy is to add 2 or more fuel lines to the car, not having any idea what the outcome will be.

[yager91]

I must have a sign on my chest that says bypass.
My 1st cardiologest  did the tests but didn't give me the results.She
just sent me to the hospital for the catherization.
The hospital cardiologest recommended double bypass. CABG
The surgeon was in cath room and signed me up for the 1st available
day to do the surgery.
Now my 1st cardiologest was out of town for a week and I was out of town
the next week.When I got back, she recommended the bypass but gave me no info.My daughter was not available for when surgery was
scheduled, so I cancelled it.
I asked for a second opinion from a cardiologest of a different hospital.
During this time the surgeon's office called about 6 times to reschedule
surgery.I looked up that CABG surgery and did not want any part of it.
I looked around for minimally-invasive bypass (robot) surgery in a different city.Had my 2nd cardiologest call and set up appointment.Second surgeon
doesn't do stents.He said it was ok to put stent in before operation.
My second cardiologest is an interventional card said if he did it I would be
put on plavix and would need to stop it for the operation.He recommended
the bypass 1st.
I told him that he could check the flow inthe RCA if he did the stent 1st.
Open up the flow and more collaterals may form.He told me that if you're
having work done on your car you want to have the complete job done.
I have an appointment to go over the test data.!!!!!!
I should send this to Readers Digest.

[ed34]

Personally from my own history and experience, I think you are very wise to question your cardiologist. I'm really not sure why he is in such a hurry to want to perform a bypass on you. It would seem logical to me to have the RCA stented, then give it 3 months to see if collateral formation increases, due to the increase in pressure available on the right side. If collateral formation increases, then there is no need for a bypass. Why not cross each bridge when needed, rather than doing everything in a short period of time and risk making your health a lot worse. I was given lots of promises regarding bypass, but my triple only lasted 3 months. I soon realised that this is not uncommon, a lot actually fail. It is likely that your LAD has been blocked for years, I agree. What is important is that you keep the LCX and RCA clear, so the collaterals can receive a good feed.

[yager91]

Talked to cardilogists. He said I should have bypass.Said if I got stent, I
would be on Plavix and would need to stop Plavix to get bypass later.
During stress test, EKG not normal but no pain except in legs. nuclear
scan abnormal.Cardilogists not know where heart is getting blood.
Surgeon thinks it may be coming from Cx and RCA(dominent).
Could be coming from collatorals.If the LAD is opened up with bypass,
There be other parts of it that would need stents. It may change flowrate
in Collaterals that are now working and the other problems of an operation. Seems like a no win situation since
I can do everything  now that I normally do without sysmptons.
One other thing, my LAD could have been blocked years ago.
What do you think?

[ed34]

Not that I'm aware of, only a scan that can see how well perfused the tissue is. In case the supply is from the RCA, I think it it were my heart, I would have the stent. I'm not so sure about the bypass though. If all the left side is oxygenated, then I fail to see a reason. Perhaps the Cardiologist can give a valid one?

[yager91]

Did scan. cardilogist said I was a paradox. Scan normal at rest,abnormal
at stress.EKG borterline. blood presure 174.
If LAD is not viable, surgeon will just Abort operation.Is there a test that can tell where blood is coming from?

[ed34]

If there is no sign of any LAD after the blockage, then I'm confused as to how the anterior of the Left Ventricle is getting a blood supply. Is it wise to go by symptoms when some people even have heart attacks and feel nothing?
Perhaps a nuclear scan would be beneficial, to see oxygen levels to heart muscle at both rest and stress?