# How would you code this catherization?



## jwschroeterjr@gmail.com (Jan 20, 2011)

PROCEDURES:
1. Right and left heart catheterization
2. Ascending aortography.
3. Coronary angiography.

PROCEDURE NOTE: The right groin was prepped and draped in the usual sterile fashion. Local anesthesia was induced with 2% lidocaine. A #7-French sheath was inserted into the right common femoral vein utilizing standard guidewire technique. A #5-French sheath was inserted into the right common femoral artery with a standard guidewire technique. A monitoring Swan was then utilized to assess the right heart filling pressures, pulmonary pressures, and a distal pulmonary capillary wedge pressure. #5-French Judkins catheters including a pigtail catheter were then utilized for coronary angiography and left ventriculogram.

FINDINGS:

RIGHT CORONARY ARTERY: The right coronary artery is a small-nondominant vessel. It is free of significant disease.

LEFT MAIN: The left main is very large in caliber and short in length. It is free of disease.

LEFT ANTERIOR DESCENDING ARTERY: The left anterior descending artery is a moderate-sized vessel with extends to and around the left ventricular apex. It is entirely free of disease. It provides one bigger diagonal branch in its proximal segment which is free of disease. There are two diagonal branches provided from the distal segment which are free of disease.

RAMUS: There is a small ramus branch present which is free of disease.

LEFT CIRCUMFLEX ARTERY: The left circumflex is a large and dominant vessel. It is entirely free of disease. It provides a large obtuse marginal branch in its proximal segment which is free of disease. The distal segment then provides a moderate-sized posterior descending branch which is free of disease.

LEFT VENTRICULOGRAM: Left ventriculography in the right anterior oblique projection demonstrated mild global hypokinesis. There may be a slight increase in hypokinesis noted in the inferoapical segment. No significant mitral regurgitation is present.

ASCENDING AORTOGRAPHY: Aortic root injection demonstrated normal aortic root size. There is 1+ to at most 2+ aortic insufficiency present.

IMPRESSIONS:
1. NORMAL HEMODYNAMIC PARAMETERS.
2. ANGIOGRAPHICALLY NORMAL CORONARY ARTERIES.
3. MILD GLOBAL LEFT VENTRICULAR DYSFUNCTION WITH AN ESTIMATED EJECTION FRACTION OF APPROXIMATELY 45% TO 50%.
4. MILD TO AT MOST MODERATE AORTIC INSUFFICIENCY.


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## Jim Pawloski (Jan 20, 2011)

jwschroeterjr@gmail.com said:


> PROCEDURES:
> 1. Right and left heart catheterization
> 2. Ascending aortography.
> 3. Coronary angiography.
> ...




93460 - R&LHC ,93567- aortic root injection

HTH,
Jim Pawloski, CIRCC


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