This 72 years old man had a CABG ten years ago with a LIMA-LAD, SVG-D1, and SVG-RCA and SVG-OM. He came for a routine cardiac CT. He did not have any significant symptoms.
The images showed a normal SVG-RCA and LIMA-LAD (FIgs. 1, 2), with an occluded SVG-D1. The SVG-OM showed a severely stenotic lesion in the mid-OM (Fig. 3).
Saphenous vein grafts as against arterial grafts have a higher incidence of complications. In this patient, the SVG-D1 was occluded along with a stenotic lesion in the SVG-OM. The patient however was asymptomatic and refused a stress thallium and any further intervention. His reasoning was that if he did not have symptoms, he did not want any procedure to be performed at all.
Dear Bhavin:
I REALLY appreciate your diligent work and effort. In addition, you are doing a great service to the radiology and cardiology community by posting these cases.
Regarding this case, we all had a "reflex" of fixing things when we see something fixable!
However, this pt is stable and asymptomatic and therefore, I think pt is absolutely right in refusing any further tests or treatment.
Posted by: JP Mishra, MD, FACC | May 13, 2006 at 05:28 AM
The question is: If he didn't have any symptoms, why was the CT done in the first place?
Posted by: Dr. Kjellevand | September 10, 2007 at 07:30 PM