“A stent could be used, and it is O.K. for some patients with left main blockages,” Dr. Sperling said. But he added that his surgical approach, using the internal thoracic arteries for the bypass grafts Jeff needed, was associated with better long-term survival and “should be a lifelong fix.”

Although most cardiac surgeons use veins to bypass arterial blockages, Dr. Sperling explained that vein bypasses sometimes also become clogged. The thoracic arteries, on the other hand, “seem to be immune to atherosclerotic buildup,” he said. Stents, even the latest medicated versions, don’t last indefinitely and may require repeat procedures.

In most bypass surgeries, the chest wall bones and muscles are separated to allow surgical access to the cardiovascular anatomy. When the thoracic arteries are used for the grafts, they can be harvested through the same incision, whereas veins must be taken from elsewhere, usually the legs.

In either case, sections of the “donor” arteries or veins are stitched to the damaged arteries to create bypasses around the obstructions.

Happily, Jeff sailed through the surgery and, after exemplary postoperative care at Vassar Brothers, was sent home in four days with instructions to gradually increase his physical activity and not lift anything heavier than five pounds to allow his chest bones to grow back together.

Although coronary artery disease does not always produce symptoms, when symptoms occur they should not be ignored but rather brought to a doctor’s attention with minimal delay. Symptoms may include unusual fatigue; decreased endurance during physical activity; shortness of breath, chest pain or discomfort upon exertion; dizziness or palpitations; unexplained arm or jaw pain; and indigestion that is unrelieved by antacids.

When my brother saw Dr. Heller, his internist, he was glad the doctor did not simply say he was fine because his EKG showed nothing abnormal. Instead, he sent him to the cardiologist, Dr. Hammoud, for further testing.