Coronary angio only. No mention of a catheter going into LV and pressures taken, and that is a must for LHC.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.
1. Left main is normal.
2. LAD is normal.
3. Left circumflex is normal.
4. RCA is dominant and normal.
Pressure dampening with tapping engagement in the RCA causing a small run of V-fib. No therapy was rendered and spontaneously reverted.
1. Normal Coronaries
2. VF secondary to cathether engagement.
Jim Pawloski, CIRCC
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