Date of Cath: 20-05-2005
Ao.Pr.Sys/diast./mean(mean) : 130/80m 100
LAD: 99% after D2, 20% distal LAD
D2: 95% osteoproximal
CX (nd): 60% ostial
OM1: 70% osteoproximal
Date of Surgery: 26-05-2005
Through a limited median sternotomy on a beating heart without conventional cardio pulmonary bypass aorto coronary saphenous vein grafting to.
-First diagonal artery
-First obtuse marginal artery
-Second right ventricular branch of right coronary artery
-Ramus Intermedius artery
-The left radial artery was grafted to the first ventricular branch of right coronary artery.
-The left internal mammary artery was grafted to left anterior descending artery.
POST OF PERIOD : He had fever in the post operative period and was managed by Dr. Ramasubramaniam (Infectious Disease Specialist). He had thrombophlebitis of right forearm which may be the cause of fever. His advice was followed.
POST OF ECHO : Paradoxical IVS motion, no other regional wall motion abnormality, LV normal in size, adequate LV function, no LV clot.
But on an Annual Check up and on undergoing 64 SLICE CT CORONARY ANGIOGRAM on 18.10.2007 the following are the findings:-
Provisional Diagnosis/Clinical Data:
Hypertension, Dyslipidemia, Chest pain, Post CABG.
64 slice CT coronary angiogram was performed by injection of 60ml of
nonionic intravenous contrast and retrospective ECG gating.
Curved reconstructions, multiplanar reformats and 3 dimensional reconstruction were performed to evaluate the coronary arterial anatomy.
LIMA graft to left anterior descending (LAD) is patent with good distal run off.
SVG to PLB is patent with good distal run off.
SVG to D1 is patent with good distal run off.
LRA to RCA is occluded.
SVG to OM is occluded.
The left main coronary artery (LMCA) reveals eccentric thin soft plaque with no significant stenosis.
The proximal LAD reveals thick calcified plaque with critical stenosis. The mid LAD is occluded.
The LCx reveals thick calcified plaques in its ostio – proximal segment causing about 50% stenosis of the ostium and 40% stenosis of the mid LCx.
The first OM reveals ostial calcified plaque causing 60% stenosis. Diatally it is well perfused. The second OM reveals ostial stenosis at 40% by calcified plaque. Distally it is well perfused and large in calibre.
The right coronary artery (RCA) reveals thrombotic occlusion of the mid segment for a length of 30 mm.
The posterior descending artery (PDA) reveals mixed plaque in its distal segment causing 30 – 40% stenosis.
Myocardium: The myocardium reveals no areas of focal thinning.