Question LHC without LV gram (via Right Radial), did not cross AV

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3
Location
Sparks, NV
Best answers
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Hi All,

It's been awhile since I've looked at dication for cardiology caths. Any help would be much appreciated. What would you code this as? Dictation is as follows:

Procedure Name
1. Sedation time: > 30 mins which I supervised throughout the case.
2. LHC without LV gram (via Right Radial), did not cross AV.
3. Selective R and L coronary angiogram

Consent
Verbal and written

Indication
1. CP
2. CAD hx
3. Elevate troponin

Sedation
Versed and Fentanyl

Complications
None

Technique
Patient was brought back to operating table, draped in sterile fashion. Time out as per protocol was initiated prior to starting the procedure. Following that, the right radial artery was assessed and located. 2% lidocaine was given surrounding area. Right radial artery was accessed, and radial sheath was in place. Cocktail of calcium channel blocker and nitro were given through the sheath. This followed by heparin bolus IV once we get the catheter and the wire down at he aortic root area. Wire was removed. TIGR and JR4 catheters were used to cannulae into the right and left coronary system, respectively. Coronary angiogram was obtained in multiple interviews. Finding as stated as below. Catheter was then disengaged, and removed over the wire. Sheath was pulled, and radial band was placed.

Estimated Blood Loss
10 cc


Findings
No LV gram was performed due to being conservative contrast giving her renal insufficiency.

Co-dominant system

Left main: very large caliber vessel with normal bifurcation of the LAD and left circumflex. Left main is free of disease

LAD: Large transapical vessel. Diffuse approximately 10% stenosis at the proximal segment of LAD. This followed by diffuse 10 to 20% stenosis at the mid LAD. The rest of the distal LAD is free of disease but torturous. Distal LAD wrap around apex. Diagonal one is a moderate caliber vessel with a high takeoff, but free of disease. Diagonal two is a small to moderate caliber vessel, and free of disease

Circumflex: Large size codominant vessel. It gives rise to 3 moderate size tortuous OM branches. Ostial OM 2 with 90%, and highly angulated takeoff, and followed by heavily torturous throughout rest of the OM segment; this particular vessel and lesion is very similar to the previous study back in 2018. TIMI flow three distally of all M2

RCA: Co-Dominant vessel, Gives rise to a PDA and PLB branch. Proximal right coronary artery 30% stenosis. Mid right coronary artery 30% stenosis with calcification-napkin ring lesion. .

Recommendations
Overall, findings of very similar to 2018 study. Patient has had minimum recurrent chest discomfort over the last two years. Recommend aggressive medical treatment.
 
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