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    What does this following lab report indicate?

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Posted on Wed, 24 May 2017 in Hypertension and Heart Disease
Question: I am a 59 yr old male with a long history of extensive vascular disease involving peripheral vessels,
cerebral vessels and coronary vessels. I had a PCI in 2012 to a intermediate ramus.

I have an aortic stenosis. I have a peak/mean gradient of 51/29 with a calculated valve area of 1.2 cm2.

My medication list is as follows:
MsContin, Lyrica, Janumet, Altace, Pradaxa, Alvesco, Bisoprolol, ASA

I have a 70% to 80% proximal lesion, 70% lesion in posterior descending proximally and a mid-vessel lesion of 90%. There is a 2+ aortic insufficiency. The aortic root angiography reveals mild ectasia.

Along with this problem I have autonomic toxic neuropathy from 40+ years of firefighting.

The surgeons said that they will not operate to place 3 stents in one artery. Now my fate rests in the hands of the creator. What else can I do when all I get is crying from the surgeons who will not do there job?

By the way, I do have the report with a diagram of the cardiac catheterization if you need it, just ask for it. Thank you.
doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM!

I passed carefully through your medical history and would like to say that there is no place for losing hope.

It is obvious that considering your multi-lesion coronary disease, both percutaneous angioplasty and coronary artery bypass could be considered as potential options.

But,facing also your concomitant aortic valve disease, the surgical strategy (which could resolve both valvular and coronary artery disease) seems the most reasonable alternative.

Whether switching to PCI or surgery will be determined by several factors (local anatomical characteristics of coronary lesions, concomitant co-morbidities, technical feasibility, level of expertise when considering each of the therapeutic alternatives, etc.), that play a role in determining the overall calculated procedure risk.

Considering your age, concomitant valvular and coronary artery disease, and no serious comorbidities (including the absence of any significant cardiac function impairment), CABG (surgery) should be seriously considered when reviewing the management strategy.

I would like to review your detailed coronary angiogram coupled with your recent cardiac ultrasound report and give a second professional opinion.

Please, could your upload them here for a direct review?

In case you have any further uncertainties, feel free to ask me again.

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 7356 Questions

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