Coronary Angiogrpahy

AshleyMartin

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The procedure report for this case is coded as a LHC w coronaries. In reading the operative report I disagree and say that it is a coronary angiography. What is correct?

Indications: The patient is a 51 year old patient with a known history of embolic CVA secondary to dignosed cardiomyopathy with apical clot. The patient was brought in for evaluation of coronary anatomy.

PROCEDURE IN DETAIL:
After informed consent was obtained, the patient was brought in the Cath Lab and placed on the table. The patient was prepped and draped in a sterile fashion. Access was obtained of the right femoral artery via modified Seldinger technique after 1% lidocaine was used to anethetize the area. A 6-French sheath was placed in the right femoral artery amd flushed without any complications. We reintroduced a JL-4 diagnosed catheter over a
.035 J-wire. This was used to selectively engage the left main artery and the left coronary system was studied. The JL-4 catheter was then exchanged over the wire. This was used to selectively engage the right coronary artery. There was significant dampening of pressure upon catheter engagement. The patient had a short run of V-fib that required no therapy or spontaneously reverted. Selective angiogram of the right femoral access site was taken. A 6-French minx was deployed to obtain hemostasis. The patient tolerated the procedure well. He was hemodynamically stable. He was transferred to the recovery area.

FINDINGS:
1. Left main is normal.
2. LAD is normal.
3. Left circumflex is normal.
4. RCA is dominant and normal.

Complications:
Pressure dampening with tapping engagement in the RCA causing a small run of V-fib. No therapy was rendered and spontaneously reverted.

Diagnosis:
1. Normal Coronaries
2. VF secondary to cathether engagement.
 

Jim Pawloski

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The procedure report for this case is coded as a LHC w coronaries. In reading the operative report I disagree and say that it is a coronary angiography. What is correct?

Indications: The patient is a 51 year old patient with a known history of embolic CVA secondary to dignosed cardiomyopathy with apical clot. The patient was brought in for evaluation of coronary anatomy.

PROCEDURE IN DETAIL:
After informed consent was obtained, the patient was brought in the Cath Lab and placed on the table. The patient was prepped and draped in a sterile fashion. Access was obtained of the right femoral artery via modified Seldinger technique after 1% lidocaine was used to anethetize the area. A 6-French sheath was placed in the right femoral artery amd flushed without any complications. We reintroduced a JL-4 diagnosed catheter over a
.035 J-wire. This was used to selectively engage the left main artery and the left coronary system was studied. The JL-4 catheter was then exchanged over the wire. This was used to selectively engage the right coronary artery. There was significant dampening of pressure upon catheter engagement. The patient had a short run of V-fib that required no therapy or spontaneously reverted. Selective angiogram of the right femoral access site was taken. A 6-French minx was deployed to obtain hemostasis. The patient tolerated the procedure well. He was hemodynamically stable. He was transferred to the recovery area.

FINDINGS:
1. Left main is normal.
2. LAD is normal.
3. Left circumflex is normal.
4. RCA is dominant and normal.

Complications:
Pressure dampening with tapping engagement in the RCA causing a small run of V-fib. No therapy was rendered and spontaneously reverted.

Diagnosis:
1. Normal Coronaries
2. VF secondary to cathether engagement.
Coronary angio only. No mention of a catheter going into LV and pressures taken, and that is a must for LHC.
HTH,
Jim Pawloski, CIRCC
 
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