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Dr .Saeed ahmed
Dr .Saeed ahmed, Doctor
Category: Cardiology
Satisfied Customers: 4469
Experience:  MBBS/FCPS(R)/MRCP U.K(R), Senior Registrar Cardiology
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How would u suggest to treat a 50% stenosis at the origin of

Resolved Question:

How would u suggest to treat a 50% stenosis at the origin of the D2
Submitted: 3 years ago.
Category: Cardiology
Expert:  Dr. Phil, MD replied 3 years ago.
Hello. I'm Dr. Phil, licensed and practicing internist. Excellent service is my goal.

Thanks for this question.

I think that this should be treated medically

Diet, exercise, statin therapy, aspirin. Also, blood pressure control, choletserol reduction, max medical therapy

I think this is the way to go.

No stents in this case.


I hope this helps.

If you have more questions, just reply. :)
Customer: replied 3 years ago.

Q1. what is this area of the heart called where the D 2 and LAD meet ?

 

Q2. Is there a name on the procedure to repair the diagonal branch?

 

Q3. In you answer to first question you suggest Diet, exercise, statin therapy, aspirin. Also, blood pressure control, choletserol reduction, max medical therapy as the best way to fix this blockage in the diagonal artery, why do you suggest this over stenting the diagonal?.

 

Q4 My consultant is suggesting to stent the LAD which has three narrowing's and pinch off the diagonal branch which also has a narrowing of 50% . would it not be better to stent the diagonal rather that pinch it off ?

 

Q5 What are the down sides of pinching off this diagonal branch?

 

Q6 how many years will my life expectancy be reduced by pinching off D2?

 

Q7 How much does this pinching off my D2 reduce the blood flow in my heart ?

 

Q8 Is it possible to have a y type stent put in to have an open diagonal and an open LAD.

 

Q9 Does it seem to be the lazy man's way to treat the narrowing's in my Diagonal branch and LAD by putting in one long stent and pinching off the Diagonal artery.

 

Q10 What is the length of a normal stent.?

 

Q11 what is the diameter size of a normal Diagonal branch.

 

Q12 How many people get this D2 stented.?

 

Q13 Why would my consultant suggest to pinch of this artery in the D2 instead of stenting?.

 

Q14 would it not be better to have blood flowing in the D2 rather than having it pinched off?

 

 

 

 

 

 

 

Expert:  Dr .Saeed ahmed replied 3 years ago.
Hello,

Thank you for your question.

I will try my best to help you with your questions.

1.. There is no specific name for the area where LAD meets D2. D2 is a branch of LAD.

2...Procedure is same PCI or per-cutaneous coronary intervention for all coronary arteries.

3...If patient has symptoms like chest pain and D2 supplies large area more than 10% then it should be stented. If there is 50% stenosis then we have to do FFR test to see if this 50% is significant.

4.5.. Down sides of pinching are that this area will not receive adequate blood and heart muscles will be damaged.

6...If D2 supplies less than 5% area of heart then the prognosis is same like 80% and more over 5 years.

7... IT depends how much area D2 is supplying, it can only be judged by angiogram and perfusion scans.

8...It is possibly to put a Y stent if the angle of the LAD and D2 is optimal, that is less than 45 degress and size are almost same.Also if D2 is supplying large area more than 10% then it is important to save this branch.

9...You can say it is lazy man's job as Y stents are difficult to place and only few experts can do it right.

10....Stents can be as small as 15mm in length and as large as 60mm in length.

11... average around 1-1.5mm they vary from person to person.

12... Very few patients get D2 stents as this is very small and no suitable stent sizes for this branch.

13...Because in most cases it is very small and supplies less than 5% of heart and there are no stents smaller to fit this branch.

14....It is better to keep it open but if we have to save LAD or D2 we always save LAD as this is big, important and supplies around 40% of heart.

I hope this answers your questions.
Kindly rate as excellent so that i can be compensated for my time and expertise. Thanks.

Dr .Saeed ahmed, Doctor
Category: Cardiology
Satisfied Customers: 4469
Experience: MBBS/FCPS(R)/MRCP U.K(R), Senior Registrar Cardiology
Dr .Saeed ahmed and other Cardiology Specialists are ready to help you
Customer: replied 3 years ago.

Thank you for your help but I need some more detail on the questions


 


Q3 what does FFR stand for?


 


Q3a how do I find out if my D2 is large or small ?


 


Q3b how do I find out what % of the heart my D2 supplied?


 


Q4+5 how do find out how much damage is done to my heart by severe ostial pinching of the small second diagonal branch subtended by the stent due to heart not receiving adequate blood supply?


 


Q6 can you tell me in lay mans terms how many years of my expectancy are lost due to pinching if blood supply was greater than 10%?


 


Q6a if my D2 was supplying 5% of my heart how many years off my life expectancy are lost when The D2 are severely pinched off


 


 


Q15 Can you explain what is the meaning of ...... there was severe ostial pinching of the small second diagonal branch sub tended by the stent but normal flow ?


 


Q15a how can blood flow be normal if the D2 is severely pinched off?


 


Q15b could this mean normal blood flow in heart


 


Q15c is this statement a contradiction normal blood flow when D2 is pinched off


 


Q15d is there any blood flow in the D2 when there is severe ostial pinching


 


thank you again but I am sure I will have a few more questions would u like to see my angioplasty results to give a more detailed opinion


 


flor



 


 


 


 

Expert:  Dr .Saeed ahmed replied 3 years ago.
FFR means fractional flow reserve used to check the severity of coronary lesion, you can predict or assess the damage and area supplied by angiogram and perfusion or nuclear studies.Pinched and normal flow means narrowing but not blockage to hinder the blood flow, prognosis with good flow and pinching is same more than 80% survival over 5 years.
Customer: replied 3 years ago.

 


Hi Dr


 


Can I get some more clarification please and answers to question again listed below.


 


when you say "Pinched and normal flow means narrowing but not blockage to hinder the blood flow",


 


I do not under stand this?


 


it seem to say if the area of the D2 has severe ostial pinching that there is narrowing on the D2 but it is not stopping the blood flow.


 


is that correct.


 


 


Q3a how do I find out if my D2 is large or small ?


 


 


 


Q3b how do I find out what % of the heart my D2 supplied?


 


 


 


Q4+5 how do find out how much damage is done to my heart by severe ostial pinching of the small second diagonal branch subtended by the stent due to heart not receiving adequate blood supply?


 


 


 


Q6 can you tell me in lay mans terms how many years of my expectancy are lost due to pinching if blood supply was greater than 10%?


 


 


 


Q6a if my D2 was supplying 5% of my heart how many years off my life expectancy are lost when The D2 are severely pinched off


 


 


 


 


 


Q15 Can you explain what is the meaning of ...... there was severe ostial pinching of the small second diagonal branch sub tended by the stent but normal flow ?


 


 


 


Q15a how can blood flow be normal if the D2 is severely pinched off?


 


 


 


Q15b could this mean normal blood flow in heart


 


 


 


Q15c is this statement a contradiction normal blood flow when D2 is pinched off


 


 


 


Q15d is there any blood flow in the D2 when there is severe ostial pinching


 


 

Expert:  Dr .Saeed ahmed replied 3 years ago.
you can predict or assess the damage and area supplied by angiogram and perfusion or nuclear studies.Pinched and normal flow means narrowing but not blockage to hinder the blood flow, prognosis with good flow and pinching is same more than 80% survival over 5 years.
Customer: replied 3 years ago.

This answer is the same as the answer before that I did not understand I still do not under


 


"Pinched and normal flow means narrowing but not blockage to hinder the blood flow"


 


can you explain what you mean by the above statement


 


 


and can you answer all the questions listed below


 


Q3a how do I find out if my D2 is large or small ?


 


 


 


 


 


 


 


Q3b how do I find out what % of the heart my D2 supplied?


 


 


 


 


 


 


 


Q4+5 how do find out how much damage is done to my heart by severe ostial pinching of the small second diagonal branch subtended by the stent due to heart not receiving adequate blood supply?


 


 


 


 


 


 


 


Q6 can you tell me in lay mans terms how many years of my expectancy are lost due to pinching if blood supply was greater than 10%?


 


 


 


 


 


 


 


Q6a if my D2 was supplying 5% of my heart how many years off my life expectancy are lost when The D2 are severely pinched off


 


 


 


 


 


 


 


 


 


 


 


Q15 Can you explain what is the meaning of ...... there was severe ostial pinching of the small second diagonal branch sub tended by the stent but normal flow ?


 


 


 


 


 


 


 


Q15a how can blood flow be normal if the D2 is severely pinched off?


 


 


 


 


 


 


 


Q15b could this mean normal blood flow in heart


 


 


 


 


 


 


 


Q15c is this statement a contradiction normal blood flow when D2 is pinched off


 


 


 


 


 


 


 


Q15d is there any blood flow in the D2 when there is severe ostial pinching


 


 


 


 


Expert:  Dr .Saeed ahmed replied 3 years ago.
3...To assess the area supplied and damaged area you need nuclear scans or perfusion scans.

4-5....As flow is normal even after pinching so no loss of survival benefit, it is same around 80% over 5 years.

15... It means that origin(osteal) of D2 is pinched but flow is normal...
Blood flow cannot be normal in case of severe pinching, it is normal in case of low or moderate pinching.

Customer: replied 3 years ago.

Q15 Blood flow in the D2 is not normal when there is severe pinching of the D2 is this correct?


 


Q16 if there is no blood flow or reduced blood flow from severe pinching that area of the heart will not receive adequate blood and heart muscles will be damaged. is this correct?


 


Q17 how best do you get the damage assessed from severe ostial pinching of the D2

Expert:  Dr .Saeed ahmed replied 3 years ago.
15...correct
16...correct
17...by nuclear and perfusion scan.
Customer: replied 3 years ago.

thank you for your help I will review them and if I have any more queries I will get back to you


this is difficult for me as I do not know a lot about my heart problems


kind regards flor

Expert:  Dr .Saeed ahmed replied 3 years ago.
You are welcome, have a nice day.
Customer: replied 3 years ago.

Hi Dr Saeed


 


I have attached my medical reports from the angioplasty and stenting I had for you assistance with my question


 


would you explain the report from the 12/04/2010 sent by Dr Mulchay?


 


This report speaks of a reasonable angiographic result and TIMI Grade III flow distally, I do not under stand this report.


 


Q 1 what is the best flow of blood I could have in my heart


 


Q2 how much is the flow of blood reduced by in my heart


 


Q3 what does TIMI grade III flow distally mean


 


Q4 what length is my stent


 


Q5 can you tell from this diagram the size in diameter of the D2 branch


 


Q6 Can you confirm from diagrams that the D2 with severe ostial pinching is not carrying blood to the area of the heart it supplied before the stenting


 


Q7 in your opinion is this D2 from diagram dated 12/04/2010 less that 45 degrees optimal so a y stent could have been fitted.


 


Q8 any general information in your opinion would also be valued


 


I have attached 3 one page reports but I don't know if they have attached correctly


 


please let me know


 


thank you for all your help


Expert:  Dr .Saeed ahmed replied 3 years ago.
Hello,

Thank you for your question,

Attach the report or upload it on mediafire and send me the link.

As these are highly technical questions and only an intervention cardiologist can answer them so my target price for interpreting the report and angiography file will be at minimum 150 dollars after deductions by justanswer.

I will reply as early as you upload the documents and angiography file.

Customer: replied 3 years ago.

Hi


 


did the medical reports get to you? I only tried to attach them to this questionnaire not on mediafire as u suggested


 


If the reports have arrived I hope they will not be made public.


 


can you confirm in total the amount I will have to pay to get my file looked at and get an opinion on.


 


if I pay this extra fee can the answers from the intervention cardiologist be taken as expert opinion in the legal world


 


and how many questions can I ask and for how long will I be allowed to ask a questions before I have to pay another fee please


 


flor


 


Expert:  Dr .Saeed ahmed replied 3 years ago.
Hello,

To maintain privacy upload your documents on mediafire.com. Make an account there it is free and give me the link of that file. After i confirm that i have received the file you can delete the original file on mediafire.com to keep privacy.

You should understand that purpose of this forum is to give knowledge and share knowledge with customers as it does not makes a doctor patient relationship. So not legal issues.

Well you can ask as many on the same topic. Unless they are repeated or too many.
Customer: replied 3 years ago.

thank you for your time may I ask


 


the meaning of : reasonable angiographic result and TIMI grade III flow distally.


 


what does the above statement mean


 


flor

Expert:  Dr .Saeed ahmed replied 3 years ago.
It means good flow and angiography was successful.
Customer: replied 3 years ago.

Hi


I had a long stent fitted into the lad to repair three lesions this process severely pinched off my D2 which had a 50% narrowing at it origin


 


can you explain the meaning of ........... severe ostial pinching of a small second diagonal branch subtended by the stent.


 


please


 


 

Customer: replied 3 years ago.

also the second diagonal which had a ostial pinching


 


in the terms of this sentence what does ostial pinching mean


 


 


 

Customer: replied 3 years ago.

hello


 


again I was asking about severe ostial pinching of my d2 can you explain the side affect of this please


 


as per my questions from during the week