bataneca
Contributor
Please help!
How would you code this one:
Boy is 9 year-old born with double outlet right ventricle with a noncommitted inlet ventricular septal defect and pulmonary stenosis. He proceeded down the route of single ventricle palliation due to mild right ventricular hypoplasia and straddling of the tricuspid valve across the VSD. Initially had placement of a right modified Blalock Taussig Thomas shunt followed by hemi-Fontan and ultimately a lateral tunnel Fontan (with multiple fenestrations). He has had a very good hemodynamic result. He plays on his high school football and basketball team. He did have desaturation from his baseline in the mid 90s to 86% during exercise. He was referred for routine post Fontan evaluation to include MRI liver elastography (yesterday) and cardiac catheterization for evaluation of his hemodynamics and potential intervention to optimize his Fontan circuit.
*
PROCEDURE: Boy was brought to the cath lab where he was anesthetized and intubated by Dr. X. Using SonoSite guidance and the percutaneous technique a 10 French sheath was inserted into the right internal jugular vein. Using the percutaneous technique, a 7-French sheath was inserted into the right femoral vein and a 6-French sheath was inserted into the right femoral artery. Using a 7 French balloon wedge catheter dynamics were obtained throughout the Fontan circuit including bilateral pulmonary artery and hepatic vein wedge pressures. It was somewhat difficult to access the right pulmonary artery but ultimately this was successful using a 5 French JR 1.5 catheter. Simultaneous hemodynamics were obtained in the right ventricle, ascending and descending aorta. Angiograms were performed in the superior vena cava, innominate vein, inferior vena cava, left ventricle and descending aorta. Attention was then directed at a small venovenous collateral off of the left innominate vein which drained to the coronary sinus. Ancef (1700 mg) was given in anticipation of placement of coils. With the assistance of a 0.035 angled glide catheter a 5 French 100 cm angled Glidecath was advanced distally into the collateral where an angiogram was performed. Three Cook Flipper MReye coils (Two 0.035 x 4 cm x 3 mm and one 0.035 x 5 cm x 5 mm) were placed in the collateral. Hand-injection angiogram showed no residual flow. All catheters and sheaths were removed and hemostasis obtained with gentle hand pressure. Anesthesia was lifted.
How would you code this one:
Boy is 9 year-old born with double outlet right ventricle with a noncommitted inlet ventricular septal defect and pulmonary stenosis. He proceeded down the route of single ventricle palliation due to mild right ventricular hypoplasia and straddling of the tricuspid valve across the VSD. Initially had placement of a right modified Blalock Taussig Thomas shunt followed by hemi-Fontan and ultimately a lateral tunnel Fontan (with multiple fenestrations). He has had a very good hemodynamic result. He plays on his high school football and basketball team. He did have desaturation from his baseline in the mid 90s to 86% during exercise. He was referred for routine post Fontan evaluation to include MRI liver elastography (yesterday) and cardiac catheterization for evaluation of his hemodynamics and potential intervention to optimize his Fontan circuit.
*
PROCEDURE: Boy was brought to the cath lab where he was anesthetized and intubated by Dr. X. Using SonoSite guidance and the percutaneous technique a 10 French sheath was inserted into the right internal jugular vein. Using the percutaneous technique, a 7-French sheath was inserted into the right femoral vein and a 6-French sheath was inserted into the right femoral artery. Using a 7 French balloon wedge catheter dynamics were obtained throughout the Fontan circuit including bilateral pulmonary artery and hepatic vein wedge pressures. It was somewhat difficult to access the right pulmonary artery but ultimately this was successful using a 5 French JR 1.5 catheter. Simultaneous hemodynamics were obtained in the right ventricle, ascending and descending aorta. Angiograms were performed in the superior vena cava, innominate vein, inferior vena cava, left ventricle and descending aorta. Attention was then directed at a small venovenous collateral off of the left innominate vein which drained to the coronary sinus. Ancef (1700 mg) was given in anticipation of placement of coils. With the assistance of a 0.035 angled glide catheter a 5 French 100 cm angled Glidecath was advanced distally into the collateral where an angiogram was performed. Three Cook Flipper MReye coils (Two 0.035 x 4 cm x 3 mm and one 0.035 x 5 cm x 5 mm) were placed in the collateral. Hand-injection angiogram showed no residual flow. All catheters and sheaths were removed and hemostasis obtained with gentle hand pressure. Anesthesia was lifted.