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ICVTS on-line discussion A How distal is distal?

AFIC/NIHD, The Mall, Rawalpindi, Pakistan

An objective method for grading of distal disease in the grafted coronary arteries

eComment: I appreciate Mr. Jalal's attempt to come up with such a bold idea of having an objective scoring system for the diffuseness of the distal coronary artery disease by probing the coronary artery [1]. I agree the author has not seen any complication of coronary probing but the reason for this could be the intentional extra care taken to avoid any such complication for the sake of the study.

Firstly, we do not have any objective scoring system for the diffuseness of the coronary artery disease but the clinical decisions of offering the benefits of CABG surgery are made not by merely looking at the twodimensional coronary angiogram, rather it is the symptoms of the patients in the presence of such disease which lead us surgeons to perform surgery in diffuse coronary artery disease.

Secondly, the distal runoff of the vessel can only be judged by careful and attentive examination of the coronary angiogram before surgery. Coronary probing might tell us the presence or absence of the distal disease in the varying form of severity but by the time we would do this it would be very late for the patient. My question to the author is: what will be his strategy once he has opened a coronary artery and has quantified the distal disease, by probing, as severe? Is he going to leave that coronary as it is or graft it there or is he going to graft it distally?

Lastly, its requirement of the time now to develop such a scoring system and it is a very good attempt by the author but to me it appears that we surgeons are going to have another excuse in our sleeves for the explanation of our mortality.

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1. Jalal A. An objective method for grading of distal disease in the grafted coronary arteries. Interact CardioVasc Thorac Surg 2007; 6:451–457.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Muhammed A. Iqbal Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Iqbal, M. A. Search for Related Content PubMed PubMed Citation Articles by Iqbal, M. A. Related Collections Related Article