Unsucessful LIMA surgery

[dazhaz]

Patient male 69 years had CABG surgery in April 2004 with the use of MIDCAB to perform a mid cath LIMA to LAD.

Following an angina episode approx 6 months ago he underwent an angiography and has been given the following diagnoses.

LAD occluded proximally. The circ. has mild irregularities. The right was a huge dominant vessel and supplied the LAD via collateral which was a bad indication of the LIMA patent. Indeed the LIMA was occluded. There were a few branches unclipped, obviously it is an unsatisfying result of his surgery. The LV on the contrast LV angiography revealed good systolic.

Any advice on what possible interventions could be applied in this case would be appreciated.

Darren.

[Douglas Bogart, MD]

The best option is a good medical program and only consider repeat surgery or an attempt at opening the occluded LAD  by  a percutaneous approach if you are having severe angina.

[Douglas Bogart, MD]

The best option still is a good medical program.

[dazhaz]

I should have given previous history which i have just retreived from files.

Paitent suffered MI in June 1998 V.R infarct thrombolysed, similar admission June 2000 diagnoses MI, in am trying to trace the patients notes to give more info but any observations would be helpful.

Darren Hazard MBCS