amym
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Does this qualify for 92937-RC and 93459-26-59?
VENTRICLES: EF calculated by contrast ventriculography was 60 %.
CORONARY VESSELS: Left main: There was a 95 % stenosis at the ostium of the vessel segment. LAD: There was a 100 % stenosis. There was good blood supply to the distal myocardium from a graft. Circumflex: The vessel was normal sized. Angiography showed minor luminal irregularities. 1st obtuse
marginal: There was a 100 % stenosis. RCA: There was a 100 % stenosis in the middle third of the vessel segment. There was poor blood supply to the distal myocardium from a graft. Graft to the LAD: The graft was a LIMA. Graft angiography showed no evidence of disease. Graft to the 1st obtuse
marginal: The graft was a saphenous vein graft from the aorta. There was a diffuse 90 % stenosis at the graft ostium. There was TIMI grade 2 flow through the graft (partial perfusion). This lesion is a likely culprit for the patient's recent myocardial infarction. It appears amenable to percutaneous intervention. Graft to the RCA: The graft was a saphenous vein graft from the aorta. There was a 100 % stenosis at the graft ostium.
PROCEDURE: The risks and alternatives of the procedures and conscious sedation were explained to the patient and informed consent was obtained. The patient was brought to the cath lab and placed on the table. The planned puncture sites were prepped and draped in the usual sterile fashion.
-- Right femoral artery access. The puncture site was infiltrated with
local anesthetic. The vessel was accessed using the modified Seldinger
technique, a wire was threaded into the vessel, and a sheath was advanced
over the wire into the vessel.
-- Left heart catheterization. A catheter was advanced to the ascending
aorta. After recording ascending aortic pressure, the catheter was
advanced across the aortic valve and left ventricular pressure was
recorded. Ventriculography was performed using power injection of contrast
agent. Imaging was performed using an RAO projection.
-- Left coronary artery angiography. A catheter was advanced to the aorta
and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
-- Right coronary artery angiography. A catheter was advanced to the
aorta and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
-- Saphenous vein graft angiography. A catheter was advanced to the aorta
and positioned at the aortic anastomosis of the graft under fluoroscopic
guidance. Angiography was performed in multiple projections using
hand-injection of contrast.
LESION INTERVENTION: A balloon angioplasty with stent was performed on the
90 % lesion in the proximal anastomosis of the saphenous vein graft from
the aorta. Following intervention there was an excellent angiographic
appearance with a 0 % residual stenosis. This was an ACC/AHA type C "high
risk" lesion for intervention. There was TIMI 2 flow before the procedure
and TIMI 3 flow after the procedure. There was no acute vessel closure.
There was no perforation. There was no dissection.
-- , using a Emerge Rx 2.50 x 15mm balloon, with 3 inflations and a
maximum inflation pressure of 10 atm.
-- A Resolute Integrity Rx 2.75 x 22mm zotarolimus-eluting stent at a
maximum inflation pressure of 10 atm.
-- A Resolute Integrity Rx 2.75 x 12mm zotarolimus-eluting stent at a
maximum inflation pressure of 15 atm.
STUDY DIAGRAM
Angiographic findings
Native coronary lesions:
7Left main: Lesion 1: 95 % stenosis.
7LAD: Lesion 1: 100 % stenosis, good graft flow.
7OM1: Lesion 1: 100 % stenosis.
7RCA: Lesion 1: 100 % stenosis, poor graft flow.
Coronary graft lesions:
7Graft to OM1: SVG 7 90 % stenosis at graft ostium, diffuse, culprit
lesion.
7Graft to RCA: SVG 7 100 % stenosis at graft ostium.
Intervention results
Coronary graft lesions:
7balloon angioplasty and stent of the 90 % stenosis in SVG (proximal anastomosis) from the aorta. Appearance excellent with 0 % residual stenosis. Stent: Resolute Integrity Rx 2.75 x 22mm. Stent: Resolute Integrity Rx 2.75 x 12mm. [Graft not pictured]
HEMODYNAMIC TABLES
Pressures: Baseline
Pressures: - HR: 63
Pressures: - Rhythm:
Pressures: -- Aortic Pressure (S/D/M): 96/62/79
Pressures: -- Left Ventricle (s/edp): 105/30/--
Outputs: Baseline
Outputs: -- CALCULATIONS: Age in years: 80.06
Outputs: -- CALCULATIONS: Body Surface Area: 1.72
Outputs: -- CALCULATIONS: Height in cm: 163.00
Outputs: -- CALCULATIONS: Sex: Female
Outputs: -- CALCULATIONS: Weight in kg: 67.10
VENTRICLES: EF calculated by contrast ventriculography was 60 %.
CORONARY VESSELS: Left main: There was a 95 % stenosis at the ostium of the vessel segment. LAD: There was a 100 % stenosis. There was good blood supply to the distal myocardium from a graft. Circumflex: The vessel was normal sized. Angiography showed minor luminal irregularities. 1st obtuse
marginal: There was a 100 % stenosis. RCA: There was a 100 % stenosis in the middle third of the vessel segment. There was poor blood supply to the distal myocardium from a graft. Graft to the LAD: The graft was a LIMA. Graft angiography showed no evidence of disease. Graft to the 1st obtuse
marginal: The graft was a saphenous vein graft from the aorta. There was a diffuse 90 % stenosis at the graft ostium. There was TIMI grade 2 flow through the graft (partial perfusion). This lesion is a likely culprit for the patient's recent myocardial infarction. It appears amenable to percutaneous intervention. Graft to the RCA: The graft was a saphenous vein graft from the aorta. There was a 100 % stenosis at the graft ostium.
PROCEDURE: The risks and alternatives of the procedures and conscious sedation were explained to the patient and informed consent was obtained. The patient was brought to the cath lab and placed on the table. The planned puncture sites were prepped and draped in the usual sterile fashion.
-- Right femoral artery access. The puncture site was infiltrated with
local anesthetic. The vessel was accessed using the modified Seldinger
technique, a wire was threaded into the vessel, and a sheath was advanced
over the wire into the vessel.
-- Left heart catheterization. A catheter was advanced to the ascending
aorta. After recording ascending aortic pressure, the catheter was
advanced across the aortic valve and left ventricular pressure was
recorded. Ventriculography was performed using power injection of contrast
agent. Imaging was performed using an RAO projection.
-- Left coronary artery angiography. A catheter was advanced to the aorta
and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
-- Right coronary artery angiography. A catheter was advanced to the
aorta and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
-- Saphenous vein graft angiography. A catheter was advanced to the aorta
and positioned at the aortic anastomosis of the graft under fluoroscopic
guidance. Angiography was performed in multiple projections using
hand-injection of contrast.
LESION INTERVENTION: A balloon angioplasty with stent was performed on the
90 % lesion in the proximal anastomosis of the saphenous vein graft from
the aorta. Following intervention there was an excellent angiographic
appearance with a 0 % residual stenosis. This was an ACC/AHA type C "high
risk" lesion for intervention. There was TIMI 2 flow before the procedure
and TIMI 3 flow after the procedure. There was no acute vessel closure.
There was no perforation. There was no dissection.
-- , using a Emerge Rx 2.50 x 15mm balloon, with 3 inflations and a
maximum inflation pressure of 10 atm.
-- A Resolute Integrity Rx 2.75 x 22mm zotarolimus-eluting stent at a
maximum inflation pressure of 10 atm.
-- A Resolute Integrity Rx 2.75 x 12mm zotarolimus-eluting stent at a
maximum inflation pressure of 15 atm.
STUDY DIAGRAM
Angiographic findings
Native coronary lesions:
7Left main: Lesion 1: 95 % stenosis.
7LAD: Lesion 1: 100 % stenosis, good graft flow.
7OM1: Lesion 1: 100 % stenosis.
7RCA: Lesion 1: 100 % stenosis, poor graft flow.
Coronary graft lesions:
7Graft to OM1: SVG 7 90 % stenosis at graft ostium, diffuse, culprit
lesion.
7Graft to RCA: SVG 7 100 % stenosis at graft ostium.
Intervention results
Coronary graft lesions:
7balloon angioplasty and stent of the 90 % stenosis in SVG (proximal anastomosis) from the aorta. Appearance excellent with 0 % residual stenosis. Stent: Resolute Integrity Rx 2.75 x 22mm. Stent: Resolute Integrity Rx 2.75 x 12mm. [Graft not pictured]
HEMODYNAMIC TABLES
Pressures: Baseline
Pressures: - HR: 63
Pressures: - Rhythm:
Pressures: -- Aortic Pressure (S/D/M): 96/62/79
Pressures: -- Left Ventricle (s/edp): 105/30/--
Outputs: Baseline
Outputs: -- CALCULATIONS: Age in years: 80.06
Outputs: -- CALCULATIONS: Body Surface Area: 1.72
Outputs: -- CALCULATIONS: Height in cm: 163.00
Outputs: -- CALCULATIONS: Sex: Female
Outputs: -- CALCULATIONS: Weight in kg: 67.10