amym
Guest
Based on the notes I see 93458-26-59 and 92928-LC, correct?
SUMMARY:
-- CORONARY CIRCULATION:
-- Graft to the distal circumflex: The graft was a large sized saphenous
vein graft from the aorta. There was a 90 % stenosis at the graft ostium.
-- RECOMMENDATIONS:
-- S/p DES 3.0 x18 Resolute SVG to LCX graft
ASA/Plavix
Staged for LAD lesion due to lesion complexity high risk PCI via LIMA
Risk factor modification
PROCEDURES PERFORMED:
-- Left coronary angiography.
-- Right coronary angiography.
-- LIMA graft angiography.
-- Saphenous vein graft angiography.
-- LIMA graft angiography.
-- Coronary Drug Eluding Stent Placement.
-- PTCA.
RECOMMENDATIONS:
S/p DES 3.0 x18 Resolute SVG to LCX graft
ASA/Plavix
Staged for LAD lesion due to lesion complexity high risk PCI via LIMA
Risk factor modification
INDICATIONS: Angina/MI: myocardial infarction without ST elevation
(NSTEMI).
VENTRICLES: There were no left ventricular global or regional wall motion
abnormalities.
CORONARY VESSELS: Left main: Normal. LAD: There was a 100 % stenosis in
the proximal third of the vessel segment. Distal LAD: There was a 95 %
stenosis. In a second lesion, there was a 70 % stenosis. Proximal
circumflex: Angiography showed moderate atherosclerosis. Distal
circumflex: Angiography showed multiple discrete lesions. RCA: There was a
100 % stenosis. distal vessel filled by bridging collaterals Distal vessel
angiography showed a medium sized vessel and moderate diffuse disease.
Graft to the LAD: The graft was a LIMA. Graft angiography showed no
evidence of disease. Graft to the distal circumflex: The graft was a large
sized saphenous vein graft from the aorta. There was a 90 % stenosis at
the graft ostium. Graft to the RCA: The graft was a saphenous vein graft
from the aorta. There was a 100 % stenosis at the graft ostium.
PROCEDURE: The risks and alternatives of the procedures and conscious
sedation were explained to the patient and informed consent was obtained.
The patient was brought to the cath lab and placed on the table. The
planned puncture sites were prepped and draped in the usual sterile
fashion.
-- Right femoral artery access. The puncture site was infiltrated with
local anesthetic. The vessel was accessed using the modified Seldinger
technique, a wire was threaded into the vessel, and a sheath was advanced
over the wire into the vessel.
-- Left coronary artery angiography. A catheter was advanced to the aorta
and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
-- Right coronary artery angiography. A catheter was advanced to the
aorta and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
-- Left internal mammary graft angiography. A catheter was advanced to
the aorta and positioned at the aortic anastomosis of the graft under
fluoroscopic guidance. Angiography was performed in multiple projections
using hand-injection of contrast.
-- Saphenous vein graft angiography. A catheter was advanced to the aorta
and positioned at the aortic anastomosis of the graft under fluoroscopic
guidance. Angiography was performed in multiple projections using
hand-injection of contrast.
-- Left internal mammary graft angiography. A catheter was advanced to
the aorta and positioned at the aortic anastomosis of the graft under
fluoroscopic guidance. Angiography was performed in multiple projections
using hand-injection of contrast.
LESION INTERVENTION:
-- Balloon angioplasty was performed, using a Emerge Rx 3.0 x 15mm
balloon, with 3 inflations and a maximum inflation pressure of 10 atm.
-- A Resolute Integrity Rx 3.00 x 18mm drug-eluting stent at a maximum
inflation pressure of 12 atm.
-- , using a NC Quantum 3.0 x 8 balloon, with 1 inflations and a maximum
inflation pressure of 15 atm.
CARDIAC INTERVENTIONS
-- Coronary Drug Eluding Stent Placement.
-- PTCA.
COMPLICATIONS:
None occurred during the cath lab visit.
STUDY DIAGRAM
Angiographic findings
Native coronary lesions:
7LAD: Lesion 1: 100 % stenosis.
7Distal LAD: Lesion 1: 95 % stenosis. Lesion 2: 70 % stenosis.
7RCA: Lesion 1: 100 % stenosis.
Coronary graft lesions:
7Graft to distal circumflex: SVG 7 90 % stenosis at graft ostium.
7Graft to RCA: SVG 7 100 % stenosis at graft ostium.
HEMODYNAMIC TABLES
Pressures: Baseline
Pressures: - HR: 73
Pressures: - Rhythm:
Pressures: -- Aortic Pressure (S/D/M): 107/57/75
Pressures: -- Left Ventricle (s/edp): 104/6/--
Outputs: Baseline
Outputs: -- CALCULATIONS: Age in years: 57.17
Outputs: -- CALCULATIONS: Body Surface Area: 2.04
Outputs: -- CALCULATIONS: Height in cm: 191.00
Outputs: -- CALCULATIONS: Sex: Male
Outputs: -- CALCULATIONS: Weight in kg: 76.20
SUMMARY:
-- CORONARY CIRCULATION:
-- Graft to the distal circumflex: The graft was a large sized saphenous
vein graft from the aorta. There was a 90 % stenosis at the graft ostium.
-- RECOMMENDATIONS:
-- S/p DES 3.0 x18 Resolute SVG to LCX graft
ASA/Plavix
Staged for LAD lesion due to lesion complexity high risk PCI via LIMA
Risk factor modification
PROCEDURES PERFORMED:
-- Left coronary angiography.
-- Right coronary angiography.
-- LIMA graft angiography.
-- Saphenous vein graft angiography.
-- LIMA graft angiography.
-- Coronary Drug Eluding Stent Placement.
-- PTCA.
RECOMMENDATIONS:
S/p DES 3.0 x18 Resolute SVG to LCX graft
ASA/Plavix
Staged for LAD lesion due to lesion complexity high risk PCI via LIMA
Risk factor modification
INDICATIONS: Angina/MI: myocardial infarction without ST elevation
(NSTEMI).
VENTRICLES: There were no left ventricular global or regional wall motion
abnormalities.
CORONARY VESSELS: Left main: Normal. LAD: There was a 100 % stenosis in
the proximal third of the vessel segment. Distal LAD: There was a 95 %
stenosis. In a second lesion, there was a 70 % stenosis. Proximal
circumflex: Angiography showed moderate atherosclerosis. Distal
circumflex: Angiography showed multiple discrete lesions. RCA: There was a
100 % stenosis. distal vessel filled by bridging collaterals Distal vessel
angiography showed a medium sized vessel and moderate diffuse disease.
Graft to the LAD: The graft was a LIMA. Graft angiography showed no
evidence of disease. Graft to the distal circumflex: The graft was a large
sized saphenous vein graft from the aorta. There was a 90 % stenosis at
the graft ostium. Graft to the RCA: The graft was a saphenous vein graft
from the aorta. There was a 100 % stenosis at the graft ostium.
PROCEDURE: The risks and alternatives of the procedures and conscious
sedation were explained to the patient and informed consent was obtained.
The patient was brought to the cath lab and placed on the table. The
planned puncture sites were prepped and draped in the usual sterile
fashion.
-- Right femoral artery access. The puncture site was infiltrated with
local anesthetic. The vessel was accessed using the modified Seldinger
technique, a wire was threaded into the vessel, and a sheath was advanced
over the wire into the vessel.
-- Left coronary artery angiography. A catheter was advanced to the aorta
and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
-- Right coronary artery angiography. A catheter was advanced to the
aorta and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
-- Left internal mammary graft angiography. A catheter was advanced to
the aorta and positioned at the aortic anastomosis of the graft under
fluoroscopic guidance. Angiography was performed in multiple projections
using hand-injection of contrast.
-- Saphenous vein graft angiography. A catheter was advanced to the aorta
and positioned at the aortic anastomosis of the graft under fluoroscopic
guidance. Angiography was performed in multiple projections using
hand-injection of contrast.
-- Left internal mammary graft angiography. A catheter was advanced to
the aorta and positioned at the aortic anastomosis of the graft under
fluoroscopic guidance. Angiography was performed in multiple projections
using hand-injection of contrast.
LESION INTERVENTION:
-- Balloon angioplasty was performed, using a Emerge Rx 3.0 x 15mm
balloon, with 3 inflations and a maximum inflation pressure of 10 atm.
-- A Resolute Integrity Rx 3.00 x 18mm drug-eluting stent at a maximum
inflation pressure of 12 atm.
-- , using a NC Quantum 3.0 x 8 balloon, with 1 inflations and a maximum
inflation pressure of 15 atm.
CARDIAC INTERVENTIONS
-- Coronary Drug Eluding Stent Placement.
-- PTCA.
COMPLICATIONS:
None occurred during the cath lab visit.
STUDY DIAGRAM
Angiographic findings
Native coronary lesions:
7LAD: Lesion 1: 100 % stenosis.
7Distal LAD: Lesion 1: 95 % stenosis. Lesion 2: 70 % stenosis.
7RCA: Lesion 1: 100 % stenosis.
Coronary graft lesions:
7Graft to distal circumflex: SVG 7 90 % stenosis at graft ostium.
7Graft to RCA: SVG 7 100 % stenosis at graft ostium.
HEMODYNAMIC TABLES
Pressures: Baseline
Pressures: - HR: 73
Pressures: - Rhythm:
Pressures: -- Aortic Pressure (S/D/M): 107/57/75
Pressures: -- Left Ventricle (s/edp): 104/6/--
Outputs: Baseline
Outputs: -- CALCULATIONS: Age in years: 57.17
Outputs: -- CALCULATIONS: Body Surface Area: 2.04
Outputs: -- CALCULATIONS: Height in cm: 191.00
Outputs: -- CALCULATIONS: Sex: Male
Outputs: -- CALCULATIONS: Weight in kg: 76.20
