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Coronary artery blockage,stenosis,bypass,distal

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Internal Medicine Specialist
Practicing since : 1998
Answered : 1579 Questions
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I HAVE BEEN DIAGNOSED WITH 50 TO 6O PERCENT BLOCKAGE OF LEFT MAIN WHICH IS PATENT WITH DISTAL DISEASE EXTENDING INTO THE OSTIUM OF THE LAD AND LCX THE MID RCA IS BLOCKED 30 PERCENT WITH LONG STABLE STENOSIS I ALSO HAVE AAA ABOUT 40MM WHAT WOULD THE PROCEDURES BE HOW MANY BYPASSES WOULD I NEED WOULD THE BYPASS BE DOEN FIRST AND LATER THE AAA

Posted Sun, 6 May 2012 in Hypertension and Heart Disease
 
 
Answered by Dr. Jasvinder Singh 1 hour later
Hello,

Thanks for posting your query.

Firstly, regarding the AAA repair. Only the symptomatic aneurysms or those which are large (> 5.5 cm) are considered for repair. Majority of aneurysms are asymptomatic. However, as abdominal aortic aneurysms expand, they may become painful and lead to pulsating sensations in the abdomen or pain in the chest or lower back. They are prone to rupture.

As your AAA is 4 cm and if there’s no abdominal pain or pulsations, then it may not be considered for repair.

The blockage of the coronary arteries is also not enough to go for the bypass surgery. Angioplasty (stent placement) is considered only when the blockage in the coronary arteries is > 70%.

I suggest consulting a cardiologist as he’ll be the best judge in considering angioplasty vs medical therapy for the treatment.

You definitely need to be on beta blockers which slow the heart rate and are cardioprotective, aspirin which is a blood thinner and statins for cholesterol lowering.

Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Coronary artery blockage,stenosis,bypass,distal 19 hours later
THE AAA HAS MURAL THROMBUS THAT IS WHY THEY ARE SAYING REPAIR NOWTHEY ARE ALSO SAYING CABG FOR THE CORONARY, WHATS YOUR OPINION IE CABG BEFORE THEY REPAIR THE AAA. ANY ADVICE APPRECIATED.
 
 
Answered by Dr. Jasvinder Singh 5 hours later
Hello,

If they are planning for the CABG, then the obstruction in the coronaries is really significant. The CABG will likely be done before the AAA repair. As there's a mural thrombus, it needs to be removed and the AAA repair done.

You should go ahead with it. However, it makes sense to get a second opinion from a cardiologist with the CD of your angiography regarding the CABG.

I sincerely hope that helps. Take care.
Above answer was peer-reviewed by
 
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