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CARDIOVASCULAR CONSULTANTS, INC.
ADULT AND PEDIATRIC CARDIOVASCULAR DISEASE

JAMES E. CROCKETT, M.D. 410 MEDICAL PLAZA
BEN D. MCCALLISTER, M.D. 4320 WORNALL ROAD
DAVID R. MCCONAHAY, M.D. KANSAS CITY, Mo. 64111
ROBERT D. CONN, M.D. (816) 931-1883

BARRY D. RUTHERFORD, M.D.
WARREN L. JOHNSON, JR., M.D.

November 21, 1979

Byron W. Walters, M.D.
1030 Avalon Road
Lawrence, Kansas 66044
RE: James W. Bee

Dear Dr. Walters:

Mr. Bee is hospitalized at St. Luke's at the present time. He had his coronary
arteriographic study carried out onl1-20-79. The procedure was uneventful.

The catheterization study confirms the presence of rather significant coronary
artery disease as anticipated. Mr. Bee has had an old complete occlusion of a
dominant right coronary artery with the occlusive process beginning in the first
portion of the vessel and extending down to the junction of the middle and distal
third. The distal third of the right coronary artery is open and profused by
collateral from the left anterior descending. The left main coronary is normal.
In the left anterior descending there is a localized area of 60-70% narrowing just
proximal to the origin of two rather small diagonal branches. The distal vessel
is of good caliber. The circumflex is normal. The left ventricular angiocardio-
gram reveals a very satisfactory left ventricular contraction with a normal left
ventricular end diastolic pressure. The left ventricular angiocardiogram is even
slightly hyperkinetic.

In summary then, Mr. Bee has old right coronary occlusion with the distal segment
supplied by the left anterior descending and at least a 60% proximal left anterior
descending lesion. The left ventricular angiocardiogram is normal. He has mild
angina but a significantly abnormal treadmill with 2-2.5 mm ST segment depression
post-exercise. In view of the above I have recommended left anterior descending

and right coronary artery bypass grafting to him. I am concerned because of the
potential impact of occlusion of his left anterior descending. This would deprive
him of circulation not only to the anterior wall but also the collateral circulation
into the distal right coronary. He is agreeable to consultation and I have asked
Dr. Arnold Killen of the Thoracic Surgery Service to sce him.

I appreciated your letter of November 16. This information is certainly useful.

I think it is obvious from your observations and Mrs. Bee's observations that he
does have labile hypertension. I am impressed that his pressure at home has varied
from 130-140/70-80. I think his higher pressure while in the office was simply
related to the emotional tension of this visit. We were not able to demonstrate any
evidence of mitral regurgitation on the left ventricular angiocardiogram and I doubt
that he has had any papillary muscle involvement. I would certainly agree that he
should be maintained on his present therapeutic program for his hypertension.