Brief Answer:
Bypass is the best way to treat aneurysm and block at the same time

Detailed Answer:
Hello, I am Dr Mody and I would be addressing your concern.
I went through the details you have provided and also the reports attached .

Univocally I would recommend Bypass surgery .

Medication can be used for control of symptoms, and take care about further increase in the blockage, but will not treat the aneurysm. Also keeping the aneurysm can have its own sets of complications which, I'm afraid, can be life threatening.

So it's always better that you proceed with a definite surgery where a bypass to LAD artery and repair of aneurysm can be done at the same time .

Regards
Dr Priyank Mody

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Brief Answer:
Surgically resect the portion and suture , normal to normal myocardium

Detailed Answer:
Now after an acute infarction of LAD territory I presume that the aneurysm is of LV cavity ( though the reports attached don't suggest so ) . Now during a surgery they would bypass the block and at the same time they remove the dead aneurysmal portion wall and suture the end to end normal myocardium thus maintaining effective LV contractility and forward cardiac output.
The other rare possibility is of coronary artery aneurysm, here too the preferred choice is surgical resection, but also a covered stent may be used to seal it off , however considering that Your doctors haven't given that as treatment option , it would be mostly LV aneurysm.
Still if at all there is any doubt you may forward the same to me and would clarify it for you . Any other reports would be helpful for more objective decision .
Regards Dr Priyank Mody

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Brief Answer:
Previously there was no aneurysm documented in 2014 -15

Detailed Answer:
Hello ,
The recent report which is a scan of myocardium perfusion , shows that there is lot of reversible heart muscle which can be retrieved with revasularisation.
The other reports attached are of his heart condition during August 2014 and subsequently April . There he had an attack involving same artery as compared to the present one , they balloon dilation and put him on medicines for the same .
In those reports there is no evidence of aneurysm, so it must be recent onset which is very common to happen after a acute anterior wall Myocardial infarction.
Lastly there is some deflection as the heart muscle which was not viable on cardiac MRI previously had reversibility in present scan , highly unusual, though perfusion scan is a better modality for the same and so I will go along with it.
By all means, as I said, if there is an aneurysm, preferred treatment of choice would be surgery followed up with medical therapy or just conserve him on medical management.
Hoping I could help .
Do ask for any clarification needed and I would be happy to help .
Regards Dr Priyank Mody

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Brief Answer:
Do go through the answer . Regards

Detailed Answer:
Hello , You have uploaded a lot many reports and the problem was they weren't in any sequence , so took time to go through them .
Now coming to the latest reports of 2016 ,
The scan shows reversibility in the myocardial perfusion , it means if you do an angioplasty or bypass it will help the patient .
I think no stent was used in 2014 , considering the MRI during that time showed irreversible damage to the heart muscle .
Now there is no mention of any aneurysm in the reports you have uploaded.
The medication he is on is good and optimum and if the pulse rate is permissible we may add beta blocker to the existing regime.
Mostly the previous angiogram had multiple arteries which were diseased , so they are suggesting a bypass surgery .
An PPI may be used as he has GERD and the best would be pantorazole , however even omeprazole is an acceptable one .

If you can localise present Angiography report , I would wish to review the same .
Also any clarification needed I would be happy to help .
Regards Dr Priyank Mody

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