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dan2074, October 27,  2020  6:02am EST

Significant Blockage in the 1st diagonal- LAD

I have a 90 % block in the larger bifurcating 1st diagonal which has a smaller upper branch making it a trifurcation lesion. My doc says bypass is not feasible, stent not possible due to the narrow spot which will push the other two vessels so i remain on medication. As it is a 90 % block it worries my family and me, so  just depending only on medication. Has anyone had similar issues as me and can they kindly say what have they done. Also i have a heart surgeon consultation tomorrow and dont know what to ask him in the present situation. should i go for a bypass , etc? any pointers or experience shared here will be great. 

4 Replies
  • AHAASAKatie
    AHAASAKatie, October 27,  2020  9:43am EST

    Good morning, I am so sorry that you are having to manage this. While the final decisions need to be made between you and your surgeon, I hope our members can help answer some general questions about heart surgery. I can share what we have on cardiac procedures and surgeries to help you as well. Please know that we are thinking of you during this time.

    Best, Katie

  • AmbassadorMR
    AmbassadorMR, October 27,  2020  10:53am EST

    Hello Dan and welcome to the support site.

    When it comes to specific questions about available treatment for artery blockages and the complications associated with treatment I would suggest getting a least a second if not third opinion regarding stenting, bypassing or any other treatment for your individual situation. My experience has shown that imaging acccuracy and reading as well as surgeon experience and expertise are very important in making a best diagnosis and treatment decision. Surgeons are not all created equal and personal experience again has shown me that you want the best surgeon with the best outcomes data and operating at a facility that is capable of handling complicated or unusual surgical procedures. I dont know where you live but I would highly recommend that you get a work up at a center of excellence for cardiac treatment so that you can build a high confidence level with your surgeon and team.

    I wish you the very best as you continue in your search for the best options in treating your heart issues. Let us know if we can be of additional support or encouragement as you continue in your journey back to full heart health.

    With Heart,


  • AmbassadorB
    AmbassadorB, October 27,  2020  12:28pm EST

    Hi Dan,

    You've received some excellent advice from Ambassador MR, and you're on the right track - with a conference with your surgeon.   The only other suggestion that I would offer - ask the Surgeon if he has any possible suggestiions regarding further "specialist" study of your situation,  There are a number of top notch clinics located around the country, with expert medical staffs that might offer an alternative procedure or medical action that your surgeon would be amenable with.  You're not questioning his experience and suggested action so much, as verifying that he has considered all possible options.   There is so much happening in the world of heart repair this day and age, that it would be reassuring to know that base has been covered.   (Mayo and Cleveland Clinic are two.) All the best!

    Ambassador B

  • JamesPL
    JamesPL, October 27,  2020  7:10pm EST

    Hi Dan,

    You've been given some great advice here and I can only ehco what has been said. Speaking from another perspective, I had multple severe blockages (physician's words) on three of the four main arteries going to my heart. For me, stenting was not an option because of the amount of blockages and the high risk as there was a concern that trying to stent could have caused part of it to break off resulting in a heart attack. I was offered bypass surgery as the safer and healthier alternative and was told that all things considered, I would have a better recovery and ultimately it would result in a better quality of life going forward. As much as I wrestled wth this, when I saw all the blockages in my chest, I knew that bypass surgery was indeed a necessity. As my doctors had told me, my recovery, although lengthy, went very well. I did all the things I was instructed to do and I believe that helped. 

    You've been given advice to seek other opinions and I don't disagree. I think that's a good idea. I didn't but I did research the surgeon and the hospital. Both had an excellent reputation so I was comfortable with the care I was getting. I believe this is very important. If you have any doubts, I think you have to consult with other doctors. 

    Regarding the procedure itself, once you have fully recovered, your life will return to normal. With cardiac rehab and my own continuation of exercise per physical therapists advice, I was feeling very much like my old self after a few months (4 or 5). That was almost nine years ago. Today I do all the things I want to do without issue. I do get some occasional chest pains and have asked my cardiologist about them but she is not concerned after she gets the results from the stress test she'll usually prescribe. 

    I hope all goes well for you and please let us know how you are doing.


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