Question Complete Cath

missadeel

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This seems to be a little more than a complete heart cath.
Any help would be appreciated.



Procedures
COMPLETE HEART CATH



Conclusion
SERVICE DATE:09/03/2020

NAME OF PROCEDURE:
Right heart catheterization, left heart catheterization, left ventricular angiogram, supravalvular aortogram, aortoiliac femoral angiogram.

INDICATIONS:
Congestive heart failure, aortic stenosis.

DESCRIPTION OF PROCEDURE:
Risks and benefits of the procedure were explained to the patient. Consent was signed. These included groin complications, bleeding, hematoma, myocardial infarction, stroke and death. He wished to proceed. He was brought to the cardiac catheterization laboratory. Right femoral area was prepped. A 7-French Swan-Ganz sheath was placed in the femoral vein. Swan-Ganz catheter placed into the right heart, pressure saturations were recorded, cardiac outputs were done. A 4-French sheath was placed in the right femoral artery in the usual fashion. A 4-French left internal mammary was placed and subselectively injected to the mammary graft. The catheter was then used to intubate the right coronary and selective injections taken. A catheter was then used to intubate the saphenous vein graft to the diagonal artery. Catheter then used to intubate the saphenous vein graft to the circumflex artery. Catheter was exchanged for a 4-French left 4-Judkins catheter into the left coronary and selective injections taken. The catheter was exchanged for a pigtail catheter with a straight wire, catheter placed across the left ventricle. Low volume left ventricular angiogram was done. The catheter was then brought across the aortic valve demonstrating no gradient. Catheter then was used for supravalvular aortogram. Catheter then brought about to the iliac bifurcation and aortoiliac femoral angiogram was performed. The catheter removed, pressure held for 20 minutes. The patient returned to his room in good stable condition, no complications.

RESULTS:
HEMODYNAMICS: RA pressure of 9, RV 28/4. Wedge pressure of 16, PA pressure 28/8, mean of 17. Aortic pressure 98/57, left ventricular pressure 125/4 on gradient. A small peak-to-peak gradient of less than 30 was noted. Cardiac output of 3.4 by thermal and a Fick of 6.5. Corresponding index 1.7 and 3.3. Valve area calculated at 1.25.

CORONARY ANGIOGRAPHY:
1. The left internal mammary is subselectively injected but is patent by virtue of flow seen during filling of the left anterior descending.
2. The right coronary artery is a dominant artery. There is 70% long area of narrowing seen in the distal artery before filling some of the posterolateral branches.
3. The saphenous vein graft to the diagonal showing an 80% narrowing seen prior to the bifurcation of the 2 diagonal branches. Otherwise, the graft appears in good condition.
4. The saphenous vein graft to the circumflex shows an excellent flow into the distal circumflex and obtuse marginal branches.
5. The left main shows mild disease, occluded left anterior descending stent just after the takeoff of a big septal perforator which has a high-grade 90% narrowing in it emanating from the stent.
6. The circumflex branch is widely patent with 60% narrowing seen proximally.

LEFT VENTRICULAR ANGIOGRAM:
Shows poor contractile function, ejection fraction of 25% to 30%.

SUPRAVALVULAR AORTOGRAM:
Shows minimally dilated aortic root. Moderate calcification of the aortic valve without significant aortic insufficiency.

AORTOILIAC FEMORAL ANGIOGRAM:
Aortoiliac showing some moderate disease at the bifurcation of the iliacs with calcification noted, particularly in the left, moderately tortuous iliac femoral system, but adequate for placement of TAVR should that be recommended.

OVERALL CONCLUSIONS:
Abnormal cardiac catheterization showing probable low flow aortic stenosis, poor left ventricular (LV) function, patent mammary graft to the left anterior descending (LAD), patent vein graft to the circumflex, patent vein graft but with high-grade 80% narrowing seen in the diagonal artery, occluded LAD and patent ramus. Moderate disease in the proximal circumflex, patent right coronary with moderate diffuse disease seen in the distal right coronary. Further evaluation for revascularization and transcatheter aortic valve replacement (TAVR) will be considered.
 
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