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What Does This Angiography Report Indicate?
Question: Patient, 77 years old male, has history of nephrectomy Patient presented with complaint of dyspnoea on exertion – II since 7-8 months but had complaint of severe breathless with perspiration since last 10 days and was admitted to hospital where he was diagnosed to have severe AS with acute LVF. Patient was advised for CAG. 2D Echo (21/01/2015) showed LVEF ~ 50%, concentric LVH, mild TR, PAH and severe AS. CAG has shown triple vessel disease, severe AS. So, patient has been advised for CABG + AVR. There were no periprocedural complications. Patient is discharged in stable haemodynamic condition.
On 5th Feb he underwent Angiography. The Angiography reports is as follows :
Indication : Pre AVR CAG, Severe AS
Approach : Right Radial Artery
Catheter : 5F TIG
NYHA / KILLIPS : 1
IABP : No
HAEMODYNAMIC Detail :
AO Sys : 150 mmHg
AO Dias : 80 mmHg
HR : 100 bpm
SPo2 : 100%
Dominance : Right-dominant
LV ANGIOGRAM: Not done
CORONARIES
LMCA : Normal
LAD : 80% lesion after D1.
D1 : Large vessel. 90% lesion at its origin.
LCX : Proximal LCX shows 80% lesion.
OM1 : Normal
RCA : Mid RCA shows 60% lesion
Right PDA shows 805 lesion.
FINAL IMPRESSION:
Pre AVR CAG
Triple Vessel Disease
Severe AS
RECOMMENDATION:
CABG + AVR.
He has been now discharged from the hospital (today 5th Feb 2015) and the discharge summary notes following :
Final Diagnosis
1. Severe Aortic Stenosis (Degenerative)
2. Coronary Artery Disease – Triple Vessel Disease
3. Hypertension
Advice : CABG (Coronary Artery Bypass Graft) + AVR (Aoratic Valve Replacement).
Questions
1. What is the risk due to any delays as Patient is not very keen to get operated for CABG + AVR in next 15 – 30 days’ time?
2. Is it a common operation for a person of this age or the risk factor increases considerably in this age?
3. Should CABG and AVR be done at the same time?
4. What quality of life can one expect after CABG + AVR in this age? Will it have any increased complication after the operation?
5. Is there any need for any further diagnosis? Or, these reports are sufficient to reach a conclusion that operation is now anyway required?
6. What type of valve one should go for (Mechanical or Tissue) at this age? Any specific brand or type recommended?
Sr. Tablets Prescribed after Angiography Morning Noon Evening Days
1 Tab. Torvason -40 1
Contents : Atorvastatin 40 mg
2 Tab. Asomex -5 1/2 1/2 1/2
Contents :Amlodipine besitate
3 Tab. Pantocid -40 1
Contents : Pantoprazole
4 Tab. Cremalax 1
Contents : Sodium Picosulfate
5 Tab. Dytor plus 1/2
Contents : Spironolactone and Torsemide
6 Tab. Matilda AF 1
Contents : Alpha Lipoic Acid, Methylcobalamin (B12), Pyridoxine (B6)
7 Tab. Droxyl (500 mg) 1 1 For 3 days
Contents : Cefadroxil
8 Tab. Deplatt A (75/150mg) 1
Contents : Acetylsalicylic Acid
On 5th Feb he underwent Angiography. The Angiography reports is as follows :
Indication : Pre AVR CAG, Severe AS
Approach : Right Radial Artery
Catheter : 5F TIG
NYHA / KILLIPS : 1
IABP : No
HAEMODYNAMIC Detail :
AO Sys : 150 mmHg
AO Dias : 80 mmHg
HR : 100 bpm
SPo2 : 100%
Dominance : Right-dominant
LV ANGIOGRAM: Not done
CORONARIES
LMCA : Normal
LAD : 80% lesion after D1.
D1 : Large vessel. 90% lesion at its origin.
LCX : Proximal LCX shows 80% lesion.
OM1 : Normal
RCA : Mid RCA shows 60% lesion
Right PDA shows 805 lesion.
FINAL IMPRESSION:
Pre AVR CAG
Triple Vessel Disease
Severe AS
RECOMMENDATION:
CABG + AVR.
He has been now discharged from the hospital (today 5th Feb 2015) and the discharge summary notes following :
Final Diagnosis
1. Severe Aortic Stenosis (Degenerative)
2. Coronary Artery Disease – Triple Vessel Disease
3. Hypertension
Advice : CABG (Coronary Artery Bypass Graft) + AVR (Aoratic Valve Replacement).
Questions
1. What is the risk due to any delays as Patient is not very keen to get operated for CABG + AVR in next 15 – 30 days’ time?
2. Is it a common operation for a person of this age or the risk factor increases considerably in this age?
3. Should CABG and AVR be done at the same time?
4. What quality of life can one expect after CABG + AVR in this age? Will it have any increased complication after the operation?
5. Is there any need for any further diagnosis? Or, these reports are sufficient to reach a conclusion that operation is now anyway required?
6. What type of valve one should go for (Mechanical or Tissue) at this age? Any specific brand or type recommended?
Sr. Tablets Prescribed after Angiography Morning Noon Evening Days
1 Tab. Torvason -40 1
Contents : Atorvastatin 40 mg
2 Tab. Asomex -5 1/2 1/2 1/2
Contents :Amlodipine besitate
3 Tab. Pantocid -40 1
Contents : Pantoprazole
4 Tab. Cremalax 1
Contents : Sodium Picosulfate
5 Tab. Dytor plus 1/2
Contents : Spironolactone and Torsemide
6 Tab. Matilda AF 1
Contents : Alpha Lipoic Acid, Methylcobalamin (B12), Pyridoxine (B6)
7 Tab. Droxyl (500 mg) 1 1 For 3 days
Contents : Cefadroxil
8 Tab. Deplatt A (75/150mg) 1
Contents : Acetylsalicylic Acid
Brief Answer:
I recommend surgery as soon as possible, bypass and a biological valve...
Detailed Answer:
Hi and thank you for asking!
I read your query and understood your concerns. In the following paragraphs I would try to answer all your queries.
1. Although the patient has a severe aortic stenosis and a three vessels disease, he hasn't a damaged heart (normal heart function). If he isn't operated he may develop heart attack, pulmonary edema (acute heart failure), syncope and even imminent death. This is why it's important to be operated as soon as possible. However the operation can wait 2-4 weeks if the patient isn't keen to do it right now. He should stay on hospital for the next 2 weeks and all efforts should be make that he accepted surgery as soon as possible.
2. This is a common operation done for the diagnosis and your age. The complications and mortality rates of cardiac surgery are age dependent. However the risk and complications for your intervention are increased in patients above 80 years.
3. It’s a common procedure in this patients to do at the same time CABG and AVR.
4. The most important beneficial effect of intervention is increased survival rates and a better quality of life. Major complications are within the first 1-3 months, which is the recovery period after cardiac surgery. There are no long term complications related to cardiac surgery.
5. There’s no need for other examinations, the data are sufficient to determine the exact diagnosis and proper treatment option.
6. I would recommend a biological valve for your age. I would like to suggest a st. XXXXXXX biological valve, however it all depend from surgeon (with which biological valve he is more familiar).
Hope this information will be of help!
Wish you health!
Dr. Benard
I recommend surgery as soon as possible, bypass and a biological valve...
Detailed Answer:
Hi and thank you for asking!
I read your query and understood your concerns. In the following paragraphs I would try to answer all your queries.
1. Although the patient has a severe aortic stenosis and a three vessels disease, he hasn't a damaged heart (normal heart function). If he isn't operated he may develop heart attack, pulmonary edema (acute heart failure), syncope and even imminent death. This is why it's important to be operated as soon as possible. However the operation can wait 2-4 weeks if the patient isn't keen to do it right now. He should stay on hospital for the next 2 weeks and all efforts should be make that he accepted surgery as soon as possible.
2. This is a common operation done for the diagnosis and your age. The complications and mortality rates of cardiac surgery are age dependent. However the risk and complications for your intervention are increased in patients above 80 years.
3. It’s a common procedure in this patients to do at the same time CABG and AVR.
4. The most important beneficial effect of intervention is increased survival rates and a better quality of life. Major complications are within the first 1-3 months, which is the recovery period after cardiac surgery. There are no long term complications related to cardiac surgery.
5. There’s no need for other examinations, the data are sufficient to determine the exact diagnosis and proper treatment option.
6. I would recommend a biological valve for your age. I would like to suggest a st. XXXXXXX biological valve, however it all depend from surgeon (with which biological valve he is more familiar).
Hope this information will be of help!
Wish you health!
Dr. Benard
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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