Can someone check this. I thought this iliofemoral would not be coded as it looks like it's part of the closure, but then towarde the end he says" the iliofemoral aniogram shows no high-grade stenosis....thanks!
TITLE OF PROCEDURE: Left and right heart catheterization; left
ventriculogram; selective coronary arteriogram, right and left; selective
coronary bypass angiogram x 3; left internal mammary artery angiogram
selective injection; right iliofemoral angiogram selective injection.
TECHNIQUE: Following preparation of the right groin, the right femoral vein
and the right femoral artery were entered. A 6 French sheath was placed in
the artery, an 8 French sheath placed in the vein. A Swan-Ganz catheter was
advanced through the right heart into the left pulmonary artery. Right heart
pressures were obtained. Cardiac output was determined after _____ technique.
The catheter was removed. A pigtail catheter was advanced across the aortic
valve retrograde into the left ventricle. Left ventriculography was performed
in the RAO projection.
This catheter was exchanged for a JL4 catheter. Left coronary arteriography
performed. Catheter exchanged for JR4 catheter. Right coronary arteriography
performed. Catheter placed into the left subclavian and exchanged for an IMT
catheter and left internal mammary artery angiography performed. Catheter
exchanged for a left bypass catheter and selective injection of an obtuse
marginal and diagonal bypass graft was obtained. The catheter was pulled back
into the sheath and right iliofemoral angiography performed, 2 projections.
The vein sheath was removed and direct compression applied. The arterial
sheath was removed and an Angio-Seal device was applied. There was no
immediate complication.
FINDINGS:
Hemodynamics: The right atrial pressure was 9. Right ventricular pressure of
34/9. Pulmonary artery pressure of 34/13 with a mean pressure of 21.
Pulmonary capillary wedge pressure was 12. Cardiac output was 3.67, for an
index of 2.21.
Left ventricular end-diastolic pressure was 10. There was no systolic
gradient across the aortic valve.
ANGIOGRAPHY: The Left ventricular regional wall motion is abnormal and the
left ventricle is dilated. There is posterobasal and diaphragmatic akinesis.
The apex is dyskinetic in a localized area and the anterolateral wall is
hypokinetic. Left ventricular ejection fraction is approximately 20%.
There is no significant mitral insufficiency. The aortic root is not dilated
and the aortic leaflets are trileaflet.
The left main coronary artery is relatively small, without high-grade
stenosis. The proximal circumflex is completely occluded. The left anterior
descending is completely occluded after the takeoff of 2 small septal
branches. There is a small, about 1.5 mm in diameter, median ramus that is
patent.
The native right coronary artery is small and nondominant without high-grade
stenosis.
There is a vein graft which is in the typical position for a right coronary
artery graft, but this connects to the posterior descending artery, which is
connected to the continuation circumflex (left dominant system).
The left internal mammary artery is patent to the LAD, without high-grade
stenosis. There is a vein graft to a small-sized 2 mm obtuse marginal branch
that has no high-grade stenosis. This goes towards the posterolateral wall.
There is also patent vein graft to a small diagonal branch without high-grade
stenosis. The iliofemoral angiogram shows no high-grade stenosis.
IMPRESSION:
1. Ischemic cardiomyopathy with markedly reduced left ventricular ejection
fraction. Patient already has an implantable defibrillator.
2 Occlusion of the circumflex and left anterior descending artery with a
patent but small nondominant right coronary artery.
3. Patent left internal mammary artery graft to the left anterior descending
artery after the total occlusion.
4. Patent vein graft to an obtuse marginal branch, the posterior descending
artery, and to a diagonal.
TITLE OF PROCEDURE: Left and right heart catheterization; left
ventriculogram; selective coronary arteriogram, right and left; selective
coronary bypass angiogram x 3; left internal mammary artery angiogram
selective injection; right iliofemoral angiogram selective injection.
TECHNIQUE: Following preparation of the right groin, the right femoral vein
and the right femoral artery were entered. A 6 French sheath was placed in
the artery, an 8 French sheath placed in the vein. A Swan-Ganz catheter was
advanced through the right heart into the left pulmonary artery. Right heart
pressures were obtained. Cardiac output was determined after _____ technique.
The catheter was removed. A pigtail catheter was advanced across the aortic
valve retrograde into the left ventricle. Left ventriculography was performed
in the RAO projection.
This catheter was exchanged for a JL4 catheter. Left coronary arteriography
performed. Catheter exchanged for JR4 catheter. Right coronary arteriography
performed. Catheter placed into the left subclavian and exchanged for an IMT
catheter and left internal mammary artery angiography performed. Catheter
exchanged for a left bypass catheter and selective injection of an obtuse
marginal and diagonal bypass graft was obtained. The catheter was pulled back
into the sheath and right iliofemoral angiography performed, 2 projections.
The vein sheath was removed and direct compression applied. The arterial
sheath was removed and an Angio-Seal device was applied. There was no
immediate complication.
FINDINGS:
Hemodynamics: The right atrial pressure was 9. Right ventricular pressure of
34/9. Pulmonary artery pressure of 34/13 with a mean pressure of 21.
Pulmonary capillary wedge pressure was 12. Cardiac output was 3.67, for an
index of 2.21.
Left ventricular end-diastolic pressure was 10. There was no systolic
gradient across the aortic valve.
ANGIOGRAPHY: The Left ventricular regional wall motion is abnormal and the
left ventricle is dilated. There is posterobasal and diaphragmatic akinesis.
The apex is dyskinetic in a localized area and the anterolateral wall is
hypokinetic. Left ventricular ejection fraction is approximately 20%.
There is no significant mitral insufficiency. The aortic root is not dilated
and the aortic leaflets are trileaflet.
The left main coronary artery is relatively small, without high-grade
stenosis. The proximal circumflex is completely occluded. The left anterior
descending is completely occluded after the takeoff of 2 small septal
branches. There is a small, about 1.5 mm in diameter, median ramus that is
patent.
The native right coronary artery is small and nondominant without high-grade
stenosis.
There is a vein graft which is in the typical position for a right coronary
artery graft, but this connects to the posterior descending artery, which is
connected to the continuation circumflex (left dominant system).
The left internal mammary artery is patent to the LAD, without high-grade
stenosis. There is a vein graft to a small-sized 2 mm obtuse marginal branch
that has no high-grade stenosis. This goes towards the posterolateral wall.
There is also patent vein graft to a small diagonal branch without high-grade
stenosis. The iliofemoral angiogram shows no high-grade stenosis.
IMPRESSION:
1. Ischemic cardiomyopathy with markedly reduced left ventricular ejection
fraction. Patient already has an implantable defibrillator.
2 Occlusion of the circumflex and left anterior descending artery with a
patent but small nondominant right coronary artery.
3. Patent left internal mammary artery graft to the left anterior descending
artery after the total occlusion.
4. Patent vein graft to an obtuse marginal branch, the posterior descending
artery, and to a diagonal.
