Complicated attempt at coil retrieval

JenReyn99

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Redding, CA
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Here is the op note: I haven't seen anything like this before, so I was hoping to get some ideas from all of you. Thanks!

Procedure: 1. Bilateral pulmonary angiogram.
2. Attempted coil retrieval

TECHNIQUE: A 7 French sheath had been previously placed in the left arm fistula. This was exchanged over wire for a 90 cm 7 French sheath. This was placed in the right atrium and then the right ventricle. The coil was well see on all views. The coil appeared to be inferior to the ring of the tricuspid valve.

Multiple attempts were made to place a catheter near left of the coil to touch over the wire. These were all unsuccessful. The location of the coil was uncertain on fluoroscopic images alone. A 4 French pigtail catheter was placed into the left pulmonary artery. A left pulmonary arteriogram was performed.

The catheter was then placed into the right pulmonary artery. A right pulmonary arteriogram was then performed. The catheters exchanged for another 5 French catheter. Additional attempts were made to get close to the coil.

These were unsuccessful. The catheter and sheath were then removed and a short 7 French sheath was left in the fistula in the left arm. This was secured in place with 2-0 silk.

Findings: Cardiac: The patient has had a previous surgery and radiopaque band is seen at the tricuspid valve. The coil was well seen inferior and slightly to the left of this valve.

Left pulmonary arteriogram: Left pulmonary arteries branch normally. No filling defects are seen. The coil was not contained in any pulmonary arteries.

Right pulmonary arteriogram: Right pulmonary artery fills normally. No filling defects are seen. The coil was not in the right pulmonary arteries.

I am super unsure on how to code this. I don't do ANY cardiac catheterizations, so I don't want to make a misstep here. Please help!
 
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