Dr. Muzaffer Bahcivan
Cardiothoracic Surgery
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I want to get a second opinion for my father. He was recently hospitalized for a myocardial infarction resulting from blocked three coronary arteries: the left anterior descending artery, circumflex artery, and right coronary artery.
Due to complete stenosis, a percutaneous coronary intervention of the right coronary artery was unsuccessful.
Further, an echocardiogram and an MRI determined that a CABG (coronary artery bypass surgery) would not be performed due to its viability. However, this decision was reached before the final tests were taken, so I would like to get a second opinion on the CABG surgery for my father. If it is possible to upload his medical report from his hospitalization, I can do that to provide more information.
I look forward to your reply.
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern.
I reviewed your father's history. However, since I could not watch your father's moving coronary angiography images, I cannot say whether coronary vessels will be grantable for CABG (coronary artery bypass surgery).
The patient had a severe infarction of the right coronary artery, and the interventional treatment was unsuccessful since myocardial infarction significantly affected the contraction of the heart. Therefore, the patient was fitted with a left ventricular assist device.
I suggest the following,
1. I do not recommend CABG until the patient is hemodynamically stable. If the patient is operated on this way, the mortality rate will be high.
2. The best way to understand whether there is viable tissue in the myocardium is myocardial perfusion scintigraphy (MPS). I think this test could not be performed because the patient was not hemodynamically stable. I recommend performing MPS after the patient has recovered.
3. MRI (magnetic resonance imaging)indicates no viable tissue in the myocardial areas fed by the right coronary artery. But there is also narrowing in the circumflex and left anterior descending arteries, and the tissues supplied by these vessels are viable. Therefore, these vessels require a bypass or interventional treatment.
4. As a result, if the patient is hemodynamically stable, I wait a few weeks, and then I do a coronary bypass if he can be separated from the assist device. Because in a few weeks, the contraction of the heart can get better, and we can do the bypass surgery safer.
5 On the other hand, I would invasively open the circumflex artery and left anterior descending artery if the patient could not wean from the assist device or if he was getting worse hemodynamically.
However, consult the specialist doctor physically and decide on the treatment plan.
I hope this helps.
Thank you, and take care.
Patient's Query
Hi doctor,
Thank you for the reply.
My family and I were able to take him to the hospital, and along with your second option, my father got the treatment he needed. They were able to place two stents and open up two of the arteries.
Thank you so much again; it was extremely helpful. I am very appreciative.
Take care.
Hi,
Welcome back to icliniq.com.
I think the coronary intervention (stent or balloon) option is the correct decision, and I believe everything will be good.
Good luck.
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