mcauffman86
Networker
During one of my physician's heart cath procedures, the catheter broke off into the left ventricle and embolized and had to be retrieved via snare. Is this a complication that I can code for? Any thoughts?
Procedure Performed:
Right and Left heart catheterization with coronary angiogram
Langston catheter retrieval using a 6 French snare
Name of Procedure:
1. Right heart catheterization using a 7.5-French Swan-Ganz floatation catheter.
2. Left heart catheterization using a 6-French Pigtail catheter.
3. Left ventricular cine angiogram using a 6-French Pigtail catheter.
4. Selective coronary angiogram using a 6L4 and 6R4 Judkins catheters.
5. Langston inner catheter was embolized to the LV during left ventriculogram requiring urgent catheter retrieval with a 6 F-12 mm Snare.
FluoroTime and Dose:
Procedure Performed:
Right and Left heart catheterization with coronary angiogram
Langston catheter retrieval using a 6 French snare
Name of Procedure:
1. Right heart catheterization using a 7.5-French Swan-Ganz floatation catheter.
2. Left heart catheterization using a 6-French Pigtail catheter.
3. Left ventricular cine angiogram using a 6-French Pigtail catheter.
4. Selective coronary angiogram using a 6L4 and 6R4 Judkins catheters.
5. Langston inner catheter was embolized to the LV during left ventriculogram requiring urgent catheter retrieval with a 6 F-12 mm Snare.
Description of Procedure:
The patient was premedicated with Versed and fentanyl and was brought into the cath lab in a fasting state. Lidocaine 1% was used as a local anesthetic. After the right groin was anesthetized, vascular access was achieved without difficulty using a Lumify vascular US systems as follows:
Ultrasound guided vascular access was performed using the Lumify vascular system.
The patient was premedicated with Versed and fentanyl and was brought into the cath lab in a fasting state. Lidocaine 1% was used as a local anesthetic. After the right groin was anesthetized, vascular access was achieved without difficulty using a Lumify vascular US systems as follows:
Ultrasound guided vascular access was performed using the Lumify vascular system.
The left common femoral artery and vein were identified by Ultrasound above the profunda femoral branch.
The vessel demonstrated good color flow and appears suitable for vascular access.
Real time live visualization of vascular needle entry and direct puncture into the left common femoral artery and vein was performed to ensure safe access to the vessel without double puncture.
Vascular access was achieved with a single puncture without difficulty. A 7 french arterial sheath and an 8F venous sheath were introduced safely with Ultrasound guidance. There are no complications.
A 7.5-French Swan-Ganz floatation catheter was advanced into the pulmonary artery position for hemodynamic monitoring. A 6-French Pigtail catheter was then advanced into the left ventricle. Left
ventricular cineangiogram was performed using the 6-French Pigtail catheter without complications. Selective coronary angiogram was performed using a 6L4 and a 6R4 Judkins catheters.
During left ventriculogram, the inner catheter of the Langston double-lumen catheter broke off and embolized and coiled up into the left ventricle.
The vessel demonstrated good color flow and appears suitable for vascular access.
Real time live visualization of vascular needle entry and direct puncture into the left common femoral artery and vein was performed to ensure safe access to the vessel without double puncture.
Vascular access was achieved with a single puncture without difficulty. A 7 french arterial sheath and an 8F venous sheath were introduced safely with Ultrasound guidance. There are no complications.
A 7.5-French Swan-Ganz floatation catheter was advanced into the pulmonary artery position for hemodynamic monitoring. A 6-French Pigtail catheter was then advanced into the left ventricle. Left
ventricular cineangiogram was performed using the 6-French Pigtail catheter without complications. Selective coronary angiogram was performed using a 6L4 and a 6R4 Judkins catheters.
During left ventriculogram, the inner catheter of the Langston double-lumen catheter broke off and embolized and coiled up into the left ventricle.
We were able to promptly retrieve the Langston inner catheter with a 6 French 12 mm snare without complication.
The patient tolerated the procedure well and was transferred to CVL recovery for post cath management.
Moderate sedation performed using IV Versed and Fentanyl.
The patient tolerated the procedure well and was transferred to CVL recovery for post cath management.
Moderate sedation performed using IV Versed and Fentanyl.
Patient received continuous EKG, hemodynamic and oximetry monitoring.
The attending physician was present and/or scrubbed for the entire procedures.
Duration: 54 minutes.
Total moderate sedation duration = 54 min. .
Hemodynamics:
Duration: 54 minutes.
Total moderate sedation duration = 54 min. .
Hemodynamics:
Aortic pressure was: | 2/6/2020 | 2/6/2020 | 2/6/2020 |
AO Systolic Pressure | 121 | 148 | 125 |
AO Diastolic Pressure | 66 | 69 | 60 |
AO Mean Pressure | 89 | 102 | 87 |
LV pressure and LVEDP was: | 2/6/2020 |
LV Systolic Pressure | 144 |
LV Diastolic Pressure | 67 |
LV End Diastolic Pressure | 77 |
Some recent data might be hidden |
Right Heart Catheterization Hemodynamic Data:
Right Heart Hemodynamics: | 2/6/2020 |
Right Atrium Mean Pressure | 13 |
Right Ventricular Systolic Pressure | 46 |
Right Ventricular Diastolic Pressure | 11 |
Right Ventricular End Diastolic | 15 |
Pulmonary Artery Systolic Pressure | 41 |
Pulmonary Artery Diastolic Pressure | 23 |
Pulmonary Artery Mean Pressure | 29 |
Pulmonary Capillary Wedge Pressure | 18 |
Cardiac output is estimated at 4.5 by thermodilution technique.
There is a mean transaortic gradient of 47 mmHg consistent with severe aortic stenosis
There is a mean transaortic gradient of 47 mmHg consistent with severe aortic stenosis
Fluoroscopy:
Demonstrated normal cardiac silhouette with visible coronary calcification.
There is visible stent in the LAD.
There are severe aortic valve calcification.
The right groin sheath was removed using Angio-Seal closure device manuel pressure with good hemostasis and without complication.
Cine Interpretation:
Demonstrated normal cardiac silhouette with visible coronary calcification.
There is visible stent in the LAD.
There are severe aortic valve calcification.
The right groin sheath was removed using Angio-Seal closure device manuel pressure with good hemostasis and without complication.
Cine Interpretation:
Dominance, right dominance.
The left main coronary artery branches into LAD and circumflex. No significant disease is seen in the left main trunk.
The left anterior descending artery gives off diagonal branches. The mid LAD stent appeared to be patent without restenosis There is 50% distal LAD stenosis.
The circumflex artery gives off obtuse marginal branchs. There is 70% proximal circumflex stenosis no siignificant disease in the circumflex artery.
The right coronary artery gives off PDA and posterolateral segment. There is 99-100% occlusion of the mid right coronary artery with bridging collaterals.
Left ventricular cineangiogram revealed normal left ventricular systolic function.
Case Classification:
The left main coronary artery branches into LAD and circumflex. No significant disease is seen in the left main trunk.
The left anterior descending artery gives off diagonal branches. The mid LAD stent appeared to be patent without restenosis There is 50% distal LAD stenosis.
The circumflex artery gives off obtuse marginal branchs. There is 70% proximal circumflex stenosis no siignificant disease in the circumflex artery.
The right coronary artery gives off PDA and posterolateral segment. There is 99-100% occlusion of the mid right coronary artery with bridging collaterals.
Left ventricular cineangiogram revealed normal left ventricular systolic function.
Case Classification:
Elective/Scheduled
Stress or Imaging Test Performed:
Stress or Imaging Test Performed:
The following procedure or procedures were reviewed: | 2/5/2020 |
Imaging modality used: | Echo |
Anginal Class:
Anti-Anginal Meds:
Anti-Anginal Meds within two weeks: | 2/5/2020 |
Meds | Beta Blocker;ACE Inhibitor;Lipid lowering agent;Platelet aggregation inhibitor |
FluoroTime and Dose:
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Complications:
Langston inner catheter was embolized to the LV during left ventriculogram requiring urgent catheter retrieval with a 6 F-12 mm Snare.
Langston inner catheter was embolized to the LV during left ventriculogram requiring urgent catheter retrieval with a 6 F-12 mm Snare.
Estimated Blood Loss:
Minimal
Final Impression:
Final Impression:
Coronary angiogram demsevere two-vessel coronary disease with severe aortic stenosis.
Right & Left heart cath and coronary angiogram was performed without complication.
Recommendation:
Patient is at increased risk for coronary bypass surgery and surgical AVR due to elderly age and increased frailty.Right & Left heart cath and coronary angiogram was performed without complication.
Recommendation:
Case was discussed with the patient and family.
We'll consider stage PCI followed by evaluation for transcatheter aortic valve replacement.
We'll consider stage PCI followed by evaluation for transcatheter aortic valve replacement.