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Is Immediate Stent Placement Required If The Reports Indicate Any Abnormality In An Enlarged Heart?

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Posted on Fri, 12 Apr 2019
Question: My Uncle, who is 60 years old has the Heart issues with the Heart-enlargement. As suggested by one of the doctor in response to our question, we got Cardiac-MRI performed.

Can you please review all the attached medical reports including MRI and let us know some suggestions and answers to the below concerns/questions.

1. Do we need to immediately perform stent or can we wait for few months to have heart-stent?

2 . What will be the life expectancy if we continue to have him on medications and not go go for stent/surgery.


Thank you
XXXX
doctor
Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
I would explain as follows:

Detailed Answer:

Hello,

The MRI concludes that there are areas of myocardial fibrosis located in the inferior-lateral regions of the left ventricle and also mild contrast enhancement in the right ventricular walls.

Those areas marked by late contrast enhancement (denoting definite myocardial scar) are mild to moderate and very localized trans-mural fibrosis/scar (from late contrast enhancement).

Considering the above MRI conclusions, it seems that coronary revascularization by means of percutaneous angioplasty (stents) would be a rational approach in the attempt to optimize his myocardial contractility and overall cardiac performance.

Now, returning to your concrete questions, I would explain that coronary revascularization therapy on my professional opinion should be performed in a programmed manner, but without delay. It doesn't seem an emergent approach to be actually necessary.

You should discuss with his attending cardiologist on the above mentioned issues and see the opportunity of scheduling a near date of eventual coronary revascularization procedure (angioplasty with stenting). The beneficial effects of the procedure are expected to be relative as some part of the affected myocardial areas are not viable (definite scar), but at the meantime the resting myocardium may regain optimal blood flow and functional recovery.

Deferring this strategy (coronary revascularization) is not expected to provide better clinical outcome.

Nevertheless, optimal medical treatment is necessary for maximizing clinical benefits and maintaining a compensated status of the chronic heart failure.

A discussion on the issue of prevention of arrhythmic cardiac death is necessary to be done (implantation of cardiac defibrillator) with his cardiologist.

Hope to have been helpful to you.

Regards,
Dr. Ilir Sharka
Cardiologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
Dr.
Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 9444 Questions

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Is Immediate Stent Placement Required If The Reports Indicate Any Abnormality In An Enlarged Heart?

Brief Answer: I would explain as follows: Detailed Answer: Hello, The MRI concludes that there are areas of myocardial fibrosis located in the inferior-lateral regions of the left ventricle and also mild contrast enhancement in the right ventricular walls. Those areas marked by late contrast enhancement (denoting definite myocardial scar) are mild to moderate and very localized trans-mural fibrosis/scar (from late contrast enhancement). Considering the above MRI conclusions, it seems that coronary revascularization by means of percutaneous angioplasty (stents) would be a rational approach in the attempt to optimize his myocardial contractility and overall cardiac performance. Now, returning to your concrete questions, I would explain that coronary revascularization therapy on my professional opinion should be performed in a programmed manner, but without delay. It doesn't seem an emergent approach to be actually necessary. You should discuss with his attending cardiologist on the above mentioned issues and see the opportunity of scheduling a near date of eventual coronary revascularization procedure (angioplasty with stenting). The beneficial effects of the procedure are expected to be relative as some part of the affected myocardial areas are not viable (definite scar), but at the meantime the resting myocardium may regain optimal blood flow and functional recovery. Deferring this strategy (coronary revascularization) is not expected to provide better clinical outcome. Nevertheless, optimal medical treatment is necessary for maximizing clinical benefits and maintaining a compensated status of the chronic heart failure. A discussion on the issue of prevention of arrhythmic cardiac death is necessary to be done (implantation of cardiac defibrillator) with his cardiologist. Hope to have been helpful to you. Regards, Dr. Ilir Sharka Cardiologist