Stents, Bypass and Aortic Surgery

I would find a second opinion from a cardiologist that specializes in aortic aneurysms etc. Most cardiologists are generalists. The echo will be good non invasive test with no radiation to measure the aneurysm. They are best if the same tech etc. does them each time. Keep in mind that they aren't going to show any issues with the LAD or RCA. The stress test can be helpful, but not the end all. The fact that he said not to worry about it concerns me. I had a cardiologist like that nearly get me killed last year.

Thanks for your reply. The cardiologist that l saw spent maybe 5 minutes. Didn't explain anything l couldn't even ask questions that l had written down. He basically said we will do an echo and nuclear stress test. No other type imaging test. I have an older friend who said that an MRI was the most accurate test to do for my condition. I'm so anxious and worried about it. If l could just get a cardiologist just to explain to me exactly what my situation is now and what the best plan is moving forward. The CT done February 2025. It was showed borderline dialation of the ascending aorta 4.5cm. l know l have already posted this previously but I'm l in danger of something happening to me. I'm scared to do any type of exercising. If the 4.5 cm is accurate will be okay until l can a better cardiologist. Can anyone with more knowledge of this please respond.

Anytime you have concerns that haven't been addressed or question that haven't been answered satisfactorily, you should get a second opinion. You should probably get one anyway. A doctor who balks at that isn't to be trusted. IMHO No doctor should be threatened by a patient getting a second opinion. You'd think doctors would welcome it.

@jris35: 1st, are you on a statin?....Do you eat fatty foods? near Blockages, in 4 arteries? Two of my brothers had triple and quadruple bypass surgeries. Today,, most likely a stent would be preferred. It's minimally invasive where bypass is major surgery. Can't help personally with the blockages except to recommend a statin & exercize if you can wait before the stent procedure. If your not having systems, how did you find out about the blockages? I would get a second opinion. But, the aneurysms we can discuss. I have EXACTLY WHAT YOU HAVE. Ascending 4.2 & Root 4.5cm. On average, the aneurysm will grow 1/3cm per year, so I have 3 years, if lucky. At 5.5cm, surgery is indicated and ascending aneurysm is considered open heart surgery, no stents are possible. The blockage stents, if done, would probably be replaced during the aneurysm procedure. I hope the 35 is not your age in your condition. There is a 99% success rate on aneurysm surgeries, so at 88 I am not too worried. Good luck with your medical procedures.

The local cardiologist said my LAD etc were fine based on a nuclear perfusion test, but I did have unusual symptoms and based on what he told me just thought maybe it was the aortic aneurysm at 4.3 to 4.4 at the root which he basically blew off for over year. That was Dec 2023 and Jan 2024. My primary care doc is the one that ordered the echo in Oct 2023 along with a CT calcium scan. In Feb & Mar the symptoms were worsening but heart sounded o.k. through the stethoscope but with a slow heart rate. My primary care ordered a second echo in May 2024. The aortic aneurysm was 4.4 to 4.7 at the root at that time. He helped me get a 2nd opinion at Mayo in Jacksonville on Jul 22, 2024. The cardiologist called me within hours to setup and angiogram with possible intervention the next week because they found a complex coronary fistula from RCA to PA and the LAD to PA along with another fistula from the bronchial artery to the PA. There were also other aneurysms including one the RCA where it joins tje root. We did that on Aug 6th and ended up doing a second right heart catheterization to check pressures etc. The didn't do the intervention because things were far more extensive and the LAD was 100% chronically occluded at the mid-LAD and one spot 60% and another 70%. The perfusion test the local guy did missed this due to all the blood flow from the complex coronary fistula. On Aug 12th, I met with the chair of cardiovascular surgery and he scheduled open heart surgery for Sep 10th and another catheter procedure on Sep 4th to block or occlude the bronchial artery to Pulmonary artery fistula since he wouldn't be able to get to it during surgery because of the heart being in the way. We talked about the possibility of doing the aorta and root while he was in there but we agreed that unless he had to open up the aorta while he was in there, we would wait because the RCA resection, complex coronary fistula ligation and double bypass was estimated to take 8 hours and 6 minutes. However, a worse case scenario Bentall procedure was on the surgical list just in case. He started on my at 7:30 AM and was finishing up around 2:30 PM. They had taken me off the heart lung machine restarted my heart, but the aortic root started to bleed and ruptured and the ascending aorta tore. It took 7 minutes to get me back on the heart lung machine etc. while the surgeon blocked the hole with his fingers. I lost 3.5 L of blood during that period. He did the Bentall procedure in an emergent situation. He chose the Edwards valve/conduit as per out discussion. Surgery was over 14 hours and I was brought to 27 hours after they put me under. I am thankful that I had the best surgeon in the state of Florida that day and that someone didn't try the stent on the LAD because likely, I wouldn't have lasted more than 5 minutes had something gone wrong. I was a close call when I was already opened up and the surgeon had everything there just in case. The done side is that due to the emergent situation, when I was put back on the heart lung machine, there was a small section of the ascending aorta near the arch he could access. It is currently thought to be at 4.4cm. So basically, I am where I was a year ago. However, my daughter told me the other day, that I am really where I "thought" I was a year ago.

So my advise is to get a thorough evaluation on the blockages and the situation with the aneurysm. When they do the angiogram it will be with possible intervention the will be able to find additional information that a CT Scan with contrast and Echo doesn't reveal. If you end up needing bypass surgery, its a possible to take care of the aneurysm if its within a certain size. You want people that do this type of surgery and procedures a lot.

In my case, the 2 cardiologists involved were good enough to now not to proceed with stents and coils on Aug 6th.

Thanks for your reply. The cardiologist that l saw spent maybe 5 minutes. Didn't explain anything l couldn't even ask questions that l had written down. He basically said we will do an echo and nuclear stress test. No other type imaging test. I have an older friend who said that an MRI was the most accurate test to do for my condition. I'm so anxious and worried about it. If l could just get a cardiologist just to explain to me exactly what my situation is now and what the best plan is moving forward. The CT done February 2025. It was showed borderline dialation of the ascending aorta 4.5cm. l know l have already posted this previously but I'm l in danger of something happening to me. I'm scared to do any type of exercising. If the 4.5 cm is accurate will be okay until l can a better cardiologist. Can anyone with more knowledge of this please respond.