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Had Heart attack, done Angio for initial block. Report shows Triple vessel disease. Should I go for open heart surgery?

Hi ,Last week my dad got heart attack immediately he was hospitalised.Doctors have done angio for the intial block.Right now he is normal.But he has three more blocks and the report says Triple vessel diease.Doctor suggested us to go for open heart surgery .But I have a query he has 50% of block in the arteris.Please suggest whether which one I need to go surgery or through medicine
Asked On : Mon, 25 Mar 2013
Answers:  5 Views:  87
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Cardiologist 's  Response
80 % block are significant block , 70-79% block can be significant or not( FFR- function flow reserve is technique to determine which block is significant) . FFR is invasive procedure and costly
second alternative is - go for stess tests( stress thallium , stress echo , TMT) , if these test shows reversible myocardial ishemia , then go head for open heart surgery or angioplasty
Answered: Mon, 25 Mar 2013
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Internal Medicine Specialist Dr. Akhilesh Dubey's  Response

Welcome to HCM,

Your father had myocardial Infraction and was investigated with angiography which is gold standard for status of coronary arteries,initial block in which infraction took place is Infarct related artery (IRA)

but the basic disease is atherosclerosis which affects other coronary arteries as well.

In his case there are multiple blocks which is called Triple vessel disease.

In such cases CABG( Coronary artery bypass Graft) open heart surgery, is treatment of choice for revascularization.Even if the block in LMCA surgery is better option.

Now a days surgery(MICAS) is less invasive and safe.

You have mentioned 50 % of blocks arteries as >80% is considered significant block it also depend on coronary anatomy and level of Ischemia caused by it if necessary it can be assessed by stress echo cardiography, stress Thallium test. if Ischemia is there then CABG is way to go.

Please discuss with your treating Cardiologist and cardiothoracic Surgeon.

Take care

Best of Luck.

Answered: Tue, 26 Mar 2013
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General & Family Physician Dr. Athish Peter Margos R's  Response
It is a good thing that your father was able to fight out of an heart attack.As a immediate measure the infarct related artery has been taken care of as well.So,that gives you time to decide on further management.The choice between surgical and medical management depends on various factors.The age of the patient,the general condition of the patient,the presence of co morbidities etc.If your father is fit ,active and without any other co morbidities then surgery is definitely the better is a definitive treatment,but medical management is not.Medicines try to prevent progression of the disease,but does very little to reduce the damage already done.In case your father has other co morbid illness as well,then medical management may be better because the risk of surgery will be high.
Answered: Wed, 31 Jul 2013
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Internal Medicine Specialist Dr. Maruti Karale's  Response

Thanks for writing to us.

Triple vessel disease is an indication for open heart surgery i.e. coronary artery bypass graft surgery also called as CABG.

There is an alternative for CABG is PTCA (Percutaneous transluminal coronary angioplasty) .

Percutaneous transluminal coronary angioplasty (PTCA) is a minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart muscle.

Decision regarding need for PTCA,CABG or conservative management depends up on :--

1.anatomy of coronary arteries whether suitable for PTCA or not,
2.percentage of block in each vessel
3.Viability of myocardium
4.Diabetic or non diabetic
5.Age and other risk factors for surgery
6.Presence of any valvular heart disease

Hence get Cardiologist opinion with review of previous angiography video recording.He can correlate all these facts and can give better advise accordingly.

Hope this will help you better.

Wish your dad happy health.
Answered: Tue, 26 Mar 2013
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General & Family Physician Dr. Sunil 's  Response
Thanks for your query.
Triple Vessel Disease can be managed without open heart surgery but some times it is better to go for surgery. Doctor would advise surgery when he has calculated risk-benefit ratio. Usually doctor suggest it when angioplasty and Stents do not work,severe disease in multiple arteries, left ventricle is not working properly and there is an imminent risk of heart damage.
I suggest you to discuss with doctor all aspects, as he would advise you wisely.

Take Care!

Answered: Mon, 25 Mar 2013
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