ngaybinhyen
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D.
CABG indicated in
1). 3 vessel disease or left main disease
2). 2 vesse in diabetic pt
3). together with aortic valve replacement
correct me if I'm wrong
-t.
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| arlete
Lucky woman!
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B - He's gonna have a PTCA.
But isn't this question a little advanced for USMLE? 
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| ngaybinhyen
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Arlete,
I did feel the Q should not be that easy. Yet, I saw "D", in which a pt with stable angina, 70% stenosis of 1 vessel + mild MR should not raise an indication for surgical care.
So I guess I don't understand the insight. Please explain
-t.
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| arlete
Lucky woman!
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I think he doesn't have a surgery indication right now, I agree with you. But the way I thought is: if he ever needs one, it might be a CABG with valve repair. But B is a candidate for PTCA, that's why I thought "no CABG for him!"
But I am not sure that's the right answer. 
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| ngaybinhyen
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Arlete,
Please take a look at this source
"It is widely agreed that surgical treatment improves survival in patients with left main coronary artery obstruction or its equivalent. The CASS Registry has demonstrated that the superiority of revascularization is equivalent in symptomatic and asymptomatic patients with disease affecting the left main coronary artery"
Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed
So I believe left main disease pts should undergo surgical treatment (regardless symptomatic or asymptomatic)
-t.
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| arlete
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Yes, you may be right, but did it compare treated to non-treated, or CABG to PTCA?
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| kpmle2
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D. A 68-year-old male with tobacco abuse and a 70% stenosis of the left circumflex
artery and mild mitral regurgitation and normal left ventricular function
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| ngaybinhyen
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Arlete,
Attached is a few ideas from Brounward's. There are a lot of studies which I dont think I can remember the name. I can send you the whole chapter if you have time to read.
Regards
-t
Attached Files:
CABG and PCI.docx (17 KB, 7 downloads)
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| arlete
Lucky woman!
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Good one, thanks!
I miss Dr. Braunwards and there's so much I forgot about cardiology, but right now I am trying to learn a little more about other issues, such as ID. Thanks for offering, thanks for teaching me.
I am changing my answer to D. 
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| ngaybinhyen
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It's always my honor to discuss and learn with you, Arlete. Although I don't have a lot of experience in adult cardiology, I love it very much. Any Q re Ped Cardiology, especially congenital heart malformations, I'd love to discuss and learn.
Regards,
-t.
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| arlete
Lucky woman!
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Oh, my...! I wouldn't be the best person for that...  I studied ped cardiology in1995, only to pass the cardiology board, but I never liked it! My "problem" is that I went for cardiology and superspecialized in arrhythmias and pacemakers very quickly, so even inside the cardiology field I have a few deficiencies.  So if you give me a malfunctioning pacemaker or ICD, chances are I know how to reprogram it, but I didn't know (or remember) that the left main coronary disease was still being corrected surgically, and PTCA is a second option in this case.
So I'm glad I had this opportunity to learn. I'll keep an eye for other good, tricky questions around. They are the worst for the tests, but the best for forum discussions.
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