Thallium/Persantine study questions

[Dave_40]

The surgeon is making some bypass while in there decisions with one key data point that I really can't understand how it told a story.

Thallium test puts nuclear dye in artery and images in detailed 3D where blood flow has gone. 2 passes, resting and chemical stress. Delta between the 2 shows where under stress you didn't get as much blood and improving blood flow via bypass or other might add value.

I'd really like to hear what other's experience was as I was stressed little due to MI based LV damage & coreg etc other taht keep my heart rate quite low and way below the delta that nuclear med doc expected as norm.

In my case:
Thallium was 20 min w/ scaner making many many slices of image of radioactive dye in heart. Persantine was Iv that made me feel a little flushed and EKG / BP every couple min while artery dialate aka chemical stress, then drug to turn off persantine and another scan at least 10 min later and lasting 15min+. Since my heart is weird they got HR up maybe 15 BPM max and really couldn't see crap in EKG progressions. Delta that was supposed to show heart muscle that was not being fed as well as norm showed little to no delta which on surface says blood supply is great but without good stress maybe means pass 2 data is worthless.

What about you folks? Scan Time / stress delta / delays to stress scan / delta in images? Impressions on value it added to your doc in decision?

 

[ALCapshaw2]

I've had MANY nuclear stress tests and they always show the same result so as far as I'm concerned, they don't learn much from that test except on the first time following an 'event' (usually a heart attack).

Have you had a heart catheterization? That test is MUCH more definitive (and also a bit more invasive ) but not really a 'big deal'. I confess I was plenty worried before my first one, but after it was over, I actually enjoyed watching the catheter moving around through my arteries. I felt NOTHING except the initial numbing needle (very tiny) and the 'warm sensation' when they injected the dye. I've lost count of the number of cath's I've had. That test is the GOLD STANDARD for determining whether to Bypass and which arteries if needed. They also usually look at the aortic valve pressure gradient and can do the other valves if indicated by (a previous) Echocardiogram.

'AL Capshaw' (Bypass and AVR, separate events)

 

[Dave_40]

I had cath for original fix and stent.
That now 6 month old data showed everything basically clear and clean which is as you'd expect after they fixed the dying guy.

Card's recomendation to surgeon includes putting in lad bypass to replace stented area where I had single artery blockage. They'd be using up the best bypass vessel, the internal mammory artery and a few minutes operative time. I don't have a clear view of why card takes this postion or if surgeon is parotting it or believes same.

 

[ALCapshaw2]

The LEFT side of the heart pumps blood to the rest of your body. My understanding is that if the LAD shuts down, it's all over. In your case, it looks like bypassing the LAD is a good preventive measure 'as long as the surgeon is in there'.

People can and do survive with very compromised Right Side arteries.

'AL Capshaw' (Bypass X3 and AVR)

 

[Dave_40]

Yes it comes down to the longevity of STENT in LAD and likelyhood that it'll need work soon vs cost of using best bypass source artery and the life of that work. No matter what the thallium study said there is a chance that once heart not compensating so much for valve and I can work on strenthening the LV there would be added flow based on bypass.

Last, I was looking at the stats and 10yr survivals look much better for bypass.

thanks again
BTW: I'm posting much more detail in a surgery date message in pre-op forumn including my take on mech vs tissue valve.