Hello, I am stuck on this procedure. Can anyone help me? Here is the report...
INDICATIONS: This is a patient of ......, who has the problem of
ischemic heart disease. She previously underwent stenting of the
circumflex marginal in 02/2006. She warrants catheterization now in
view of a question of chest discomfort and palpitations in the setting
of diabetes, atrial fibrillation and hypertension. She has previously
had an abdominal aortic aneurysm repaired. It proved difficult to
manipulate a wire up the iliofemoral system. Descending aortography and
bilateral iliofemoral angiography was, therefore, also indicated in view
of peripheral vascular disease and abdominal aortic aneurysm.
NAME OF PROCEDURE:
Standard left heart catheterization procedure note.
DESCRIPTION OF PROCEDURE: The patient was brought to the cardiac
catheterization laboratory in the fasting state. After customary
prepping and draping, the groin was anesthetized with 1% Xylocaine local
anesthesia. The femoral artery was cannulated using the Seldinger
technique. A 5-French sheath was placed. A 5-French pigtail catheter
was advanced to the central aorta, and a central aortic pressure was
recorded. The pigtail catheter was then placed across the aortic valve
into the left ventricle. A left ventricular pressure was recorded on a
200 mm scale.
A left ventriculogram was performed in the right anterior oblique view
using an injection of 12 mL of contrast for a total of 1-1/2 seconds (18
mL of contrast). A pullback from the left ventricle to the aorta was
recorded under pressure monitoring. The pigtail catheter was then
removed over a guidewire.
The right and left coronary arteries were then sequentially cannulated
using 5-French diagnostic catheters. Each coronary artery was filmed in
multiple views using small hand injections of contrast.
NAMES OF PROCEDURES:
1. Descending aortogram.
2. Bilateral iliofemoral angiography.
DESCRIPTION OF PROCEDURE: In view of a question of significant
peripheral vascular disease, descending aortography and bilateral
iliofemoral angiography were performed.
To this end, a pigtail catheter was positioned in the descending aorta
below the level of L1. Injection was performed using 20 mL of
dye/second, for a total of 30 mL. Injection was performed on a 9 inch
mode with acquisition in digital format. The abdominal aorta was
visualized and recorded.
Both iliofemoral arteries were filled with dye and were imaged and
recorded in the posteroanterior view on a 9 inch mode with acquisition
in digital format.
ANGIO-SEAL PROCEDURE: Right femoral angiography was performed in a
shallow angulated view on a 9 inch mode with acquisition in digital
format. The common femoral artery and proximal portions of the
profunda, femoris and superficial femoral arteries were visualized and
recorded. When it was clear that there was no severe peripheral
vascular disease identified on this angiogram, the Angio-Seal device was
utilized for puncture closure.
At the end of the procedure, the coronary catheter was removed from the
arterial sheath. The femoral arterial sheath was removed, and
hemostasis was achieved. The patient returned to the floor in stable
condition without chest pain and with stable hemodynamics.
CARDIAC CATHETERIZATION FINDINGS:
CARDIAC FLUOROSCOPY: A stent was noted in the circumflex coronary
artery and 1+ calcification was seen in the left main coronary artery,
left anterior descending and circumflex. The cardiac silhouette was
enlarged.
LEFT VENTRICULOGRAPHY: The ejection fraction was approximately 30%. No
regional left ventricular wall motion abnormalities. No mitral
regurgitation.
HEMODYNAMICS: Left ventricular end diastolic pressure was 15 mmHg.
DESCENDING AORTOGRAPHY: The descending aorta manifested a small
suprarenal abdominal aortic aneurysm. Aorta was irregular. The renal
arteries were single and normal. The superior mesenteric artery and
celiac axis were normal.
BILATERAL ILIOFEMORAL ANGIOGRAPHY: The right common iliac had a 25%
irregularity. The right external iliac had a 30% long stenosis. The
right common femoral artery and proximal superficial femoral and
profunda were grossly normal.
The left common iliac had a 20% irregularity. The left external iliac
had an 80% stenosis.
CORONARY ARTERIOGRAPHY:
LEFT CORONARY ARTERY: The left anterior descending and the circumflex
arose in an essentially cloacal fashion from the left coronary cusp.
There was a 20% left anterior descending irregularity at the origin of
the first diagonal.
The second circumflex marginal branch manifested a 0% irregularity at
the site of a 2.25 x 18 mm Mini Vision stent (02/2006). There was a 10%
irregularity in the circumflex beyond the second marginal. The distal
circumflex was dominant.
RIGHT CORONARY ARTERY: Small, nondominant and normal.
IMPRESSION:
1. Widely patent second circumflex marginal at the site of prior
stenting in 02/2006, a 2.25 x 18 mm Mini Vision stent.
2. There is scattered mild nonsignificant coronary disease.
3. Moderate global hypokinesis compatible with a congestive
cardiomyopathy.
4. Small abdominal aortic aneurysm, suprarenal.
5. Peripheral vascular disease as defined above.
INDICATIONS: This is a patient of ......, who has the problem of
ischemic heart disease. She previously underwent stenting of the
circumflex marginal in 02/2006. She warrants catheterization now in
view of a question of chest discomfort and palpitations in the setting
of diabetes, atrial fibrillation and hypertension. She has previously
had an abdominal aortic aneurysm repaired. It proved difficult to
manipulate a wire up the iliofemoral system. Descending aortography and
bilateral iliofemoral angiography was, therefore, also indicated in view
of peripheral vascular disease and abdominal aortic aneurysm.
NAME OF PROCEDURE:
Standard left heart catheterization procedure note.
DESCRIPTION OF PROCEDURE: The patient was brought to the cardiac
catheterization laboratory in the fasting state. After customary
prepping and draping, the groin was anesthetized with 1% Xylocaine local
anesthesia. The femoral artery was cannulated using the Seldinger
technique. A 5-French sheath was placed. A 5-French pigtail catheter
was advanced to the central aorta, and a central aortic pressure was
recorded. The pigtail catheter was then placed across the aortic valve
into the left ventricle. A left ventricular pressure was recorded on a
200 mm scale.
A left ventriculogram was performed in the right anterior oblique view
using an injection of 12 mL of contrast for a total of 1-1/2 seconds (18
mL of contrast). A pullback from the left ventricle to the aorta was
recorded under pressure monitoring. The pigtail catheter was then
removed over a guidewire.
The right and left coronary arteries were then sequentially cannulated
using 5-French diagnostic catheters. Each coronary artery was filmed in
multiple views using small hand injections of contrast.
NAMES OF PROCEDURES:
1. Descending aortogram.
2. Bilateral iliofemoral angiography.
DESCRIPTION OF PROCEDURE: In view of a question of significant
peripheral vascular disease, descending aortography and bilateral
iliofemoral angiography were performed.
To this end, a pigtail catheter was positioned in the descending aorta
below the level of L1. Injection was performed using 20 mL of
dye/second, for a total of 30 mL. Injection was performed on a 9 inch
mode with acquisition in digital format. The abdominal aorta was
visualized and recorded.
Both iliofemoral arteries were filled with dye and were imaged and
recorded in the posteroanterior view on a 9 inch mode with acquisition
in digital format.
ANGIO-SEAL PROCEDURE: Right femoral angiography was performed in a
shallow angulated view on a 9 inch mode with acquisition in digital
format. The common femoral artery and proximal portions of the
profunda, femoris and superficial femoral arteries were visualized and
recorded. When it was clear that there was no severe peripheral
vascular disease identified on this angiogram, the Angio-Seal device was
utilized for puncture closure.
At the end of the procedure, the coronary catheter was removed from the
arterial sheath. The femoral arterial sheath was removed, and
hemostasis was achieved. The patient returned to the floor in stable
condition without chest pain and with stable hemodynamics.
CARDIAC CATHETERIZATION FINDINGS:
CARDIAC FLUOROSCOPY: A stent was noted in the circumflex coronary
artery and 1+ calcification was seen in the left main coronary artery,
left anterior descending and circumflex. The cardiac silhouette was
enlarged.
LEFT VENTRICULOGRAPHY: The ejection fraction was approximately 30%. No
regional left ventricular wall motion abnormalities. No mitral
regurgitation.
HEMODYNAMICS: Left ventricular end diastolic pressure was 15 mmHg.
DESCENDING AORTOGRAPHY: The descending aorta manifested a small
suprarenal abdominal aortic aneurysm. Aorta was irregular. The renal
arteries were single and normal. The superior mesenteric artery and
celiac axis were normal.
BILATERAL ILIOFEMORAL ANGIOGRAPHY: The right common iliac had a 25%
irregularity. The right external iliac had a 30% long stenosis. The
right common femoral artery and proximal superficial femoral and
profunda were grossly normal.
The left common iliac had a 20% irregularity. The left external iliac
had an 80% stenosis.
CORONARY ARTERIOGRAPHY:
LEFT CORONARY ARTERY: The left anterior descending and the circumflex
arose in an essentially cloacal fashion from the left coronary cusp.
There was a 20% left anterior descending irregularity at the origin of
the first diagonal.
The second circumflex marginal branch manifested a 0% irregularity at
the site of a 2.25 x 18 mm Mini Vision stent (02/2006). There was a 10%
irregularity in the circumflex beyond the second marginal. The distal
circumflex was dominant.
RIGHT CORONARY ARTERY: Small, nondominant and normal.
IMPRESSION:
1. Widely patent second circumflex marginal at the site of prior
stenting in 02/2006, a 2.25 x 18 mm Mini Vision stent.
2. There is scattered mild nonsignificant coronary disease.
3. Moderate global hypokinesis compatible with a congestive
cardiomyopathy.
4. Small abdominal aortic aneurysm, suprarenal.
5. Peripheral vascular disease as defined above.