My father had a heart attack. Is CABG still possible?

Question

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 (magnetic resonance imaging) 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.

Please help.

Thank you.

Answer 1

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 the coronary vessels will be suitable for CABG (coronary artery bypass surgery).

The patient had a severe infarction of the right coronary artery, and the coronary 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 more safely.

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.

Answer 2

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.

I hope this helps.

Thank you.