indirakumaris
Contributor
Hi
please confirm on the selected CPT is correct for the below reports.
CABG- 33518/33533
AVR -33365/33369
PREOPERAITVE DIAGNOSIS:
1. Aortic Stenosis
2. Coronary artery disease.
PROCEDURE PERFORMED
1. Aortic valve replacement with a 21 mm bioprosthetic valve.
2. Coronary artery bypass grafting x3.
GRAFTS:
Left internal mammary artery to the LAD, vein graft to the
posterolateral branch of the right and to the first diagonal.
FIRST ASSISTANT:
xxxx
ANESTHESIA:
General Endotracheal with cardiopulmonary bypass.
INDICATIONS:
Patient is a 77-year-old male who presents with congestive heart
failure and was found to have critical aortic stenosis on his
catheter. He was also found to have two vessel plus branch
disease. He has been referred for surgery.
DESCRIPTION OF PROCEDURE:
Patient was brought to the operative room, placed in the supine position. After sucessful induction of general anesthesia and endotracheal intubation and placement of hemodynamic monitoring lines, he was prepped and draped from his chin to his toes. midline sternotomy incision was made, dissection carried down to the sternum with electrocautery. Sternum divided midline with pneumatic saw. Left sternal blade was elevated, his IMA taken down on a pedicle and drain placed in his left pleural space. Simultaneously, greater saphenous vein was harvested from his left lower extremity. This was done endoscopically through a small incision at his knee. The vein was retrieved from his groin to just below his knee. After this, the vein was prepped as a conduit. The incision at the knee was closed in layers. A systemic dose of heparin was given. Pursestring sutures were placed. He was cannulated, placed on full cardiopulmonary bypass. An aortic cross clamp was placed. It should be noted that throughout the proceudre, patient received cardioplegia in antegrade and retrograde fashion and this was repeated every 20 minutes. After prompt diastolic arrest, an aortotomy was performed. The valve was identified and he had heavily diseased noncoronary leaflet calcification. The leaflets were excised, annulus debrided and attention turned towards the distal anastomoses. First vein graft was anastomosed to the first diagonal. This was a good target. Next, vein was anastomosed to the posterolateral branch of the right. This was also a good target. Next, attention was turned back towards the aortic annulus. Circumferentially 2-0 pledgeted Ethibond sutures were placed with the pledgets on the ventricular side. It was sized and a 21 mm St. Jude bioprosthetic graft was brought up. The sutures all passed through the sewing ring. Valve seated sutures tied and cut. An aortotomy was closed with 3-0 running Prolene suture. It should be noted that throughout the procedure, carbon dioxide was floated across the inteaoperative field to aid with de-airing. Next, the IMA was anastomosed to the proximal LAD. This was done in an end-to-side anastomosis. Under single cross clamp technique, 2 proximal anastomoses were performed with 4.0 mm punch sites. After this, the side biting clamps were removed, vein grafts deaired, sutures tied and cut. The patient developed spontaneous contractions with good blood pressure generation. He is weaned from bypass without difficulties. Protamine given to reverse heparin effect. Temporary pacing wires were placed on his ventricle, brought out through sepearte stab incisions and secured. Sternum was reapproximated with wires in addition to two sternal plates. The remainder of the wound was closed in layers. Skin closed with subcuticular suture. Sterile dressings were placed. The patient was taken to the ICU in satisfactory condition. Pump time was 122 minutes. Clamp time was 103 minutes.
Thanks for Ur help.
Indira
please confirm on the selected CPT is correct for the below reports.
CABG- 33518/33533
AVR -33365/33369
PREOPERAITVE DIAGNOSIS:
1. Aortic Stenosis
2. Coronary artery disease.
PROCEDURE PERFORMED
1. Aortic valve replacement with a 21 mm bioprosthetic valve.
2. Coronary artery bypass grafting x3.
GRAFTS:
Left internal mammary artery to the LAD, vein graft to the
posterolateral branch of the right and to the first diagonal.
FIRST ASSISTANT:
xxxx
ANESTHESIA:
General Endotracheal with cardiopulmonary bypass.
INDICATIONS:
Patient is a 77-year-old male who presents with congestive heart
failure and was found to have critical aortic stenosis on his
catheter. He was also found to have two vessel plus branch
disease. He has been referred for surgery.
DESCRIPTION OF PROCEDURE:
Patient was brought to the operative room, placed in the supine position. After sucessful induction of general anesthesia and endotracheal intubation and placement of hemodynamic monitoring lines, he was prepped and draped from his chin to his toes. midline sternotomy incision was made, dissection carried down to the sternum with electrocautery. Sternum divided midline with pneumatic saw. Left sternal blade was elevated, his IMA taken down on a pedicle and drain placed in his left pleural space. Simultaneously, greater saphenous vein was harvested from his left lower extremity. This was done endoscopically through a small incision at his knee. The vein was retrieved from his groin to just below his knee. After this, the vein was prepped as a conduit. The incision at the knee was closed in layers. A systemic dose of heparin was given. Pursestring sutures were placed. He was cannulated, placed on full cardiopulmonary bypass. An aortic cross clamp was placed. It should be noted that throughout the proceudre, patient received cardioplegia in antegrade and retrograde fashion and this was repeated every 20 minutes. After prompt diastolic arrest, an aortotomy was performed. The valve was identified and he had heavily diseased noncoronary leaflet calcification. The leaflets were excised, annulus debrided and attention turned towards the distal anastomoses. First vein graft was anastomosed to the first diagonal. This was a good target. Next, vein was anastomosed to the posterolateral branch of the right. This was also a good target. Next, attention was turned back towards the aortic annulus. Circumferentially 2-0 pledgeted Ethibond sutures were placed with the pledgets on the ventricular side. It was sized and a 21 mm St. Jude bioprosthetic graft was brought up. The sutures all passed through the sewing ring. Valve seated sutures tied and cut. An aortotomy was closed with 3-0 running Prolene suture. It should be noted that throughout the procedure, carbon dioxide was floated across the inteaoperative field to aid with de-airing. Next, the IMA was anastomosed to the proximal LAD. This was done in an end-to-side anastomosis. Under single cross clamp technique, 2 proximal anastomoses were performed with 4.0 mm punch sites. After this, the side biting clamps were removed, vein grafts deaired, sutures tied and cut. The patient developed spontaneous contractions with good blood pressure generation. He is weaned from bypass without difficulties. Protamine given to reverse heparin effect. Temporary pacing wires were placed on his ventricle, brought out through sepearte stab incisions and secured. Sternum was reapproximated with wires in addition to two sternal plates. The remainder of the wound was closed in layers. Skin closed with subcuticular suture. Sterile dressings were placed. The patient was taken to the ICU in satisfactory condition. Pump time was 122 minutes. Clamp time was 103 minutes.
Thanks for Ur help.
Indira