Please look at this and give your advice. 33340-53? Pt has existing device.
Left Atrial Appendage Angiogram Report
Conclusion:: Small stump at the ostium of the left atrial appendage less than 10 mm beyond the circumflex with no distal appendage or residual leak therefore after left atrial pended angiography to confirm the echo findings no appendage closure was performed
Pre Procedure Diagnosis: Paroxysmal atrial fibrillation
Post Procedure Diagnosis: same
Procedures Performed:
1. Transseptal Left & Right Heart Catheterization
2. Left Atrial Angiography
3.Vascular access using ultrasound
Complications: None, with NO evidence of significant pericardial effusion at the end of the procedure as verified by TEE
Procedure:
The patients presenting rhythm was sinus. The patient was brought to the electrophysiology laboratory in a fasting state. .The patient received preprocedure IV antibiotics.
The transesophageal echo probe had been placed prior to vascular access by the echocardiographer. Baseline imaging revealed No evidence of any leak around the previously implanted lariat. There was a stump however the largest measurements were 10 mm in depth and was borderline criteria whether we could implant a closure device.
I decided we should release to left atrial pended angiography to verify the absence of any other residual anatomic variants.
Right femoral venipuncture was performed using ultrasound access and a long guidewire was advanced up to the SVC. Next the 8.5 French large curl deflectable Jiles sheath transseptal sheath was advanced up to the SVC and t using an NR G needle and transesophageal echo imaging a transseptal puncture was performed and the sheath was advanced to the left side.
A pigtail catheter was placed after measuring pressures in the left atrium and angiography was performed of the left atrial appendage which in orthogonal views confirmed my suspicion that there was no leak into a remnant left atrial appendage and this was a small stump without depth for adequate closure.
The system was removed with careful avoidance of the pacemaker leads and vascular access was closed using a Vascade device and figure-of-eight stopcock/suture.
The patient tolerated the procedure well and left the electrophysiology lab in stable condition.
Left Atrial Appendage Angiogram Report
Conclusion:: Small stump at the ostium of the left atrial appendage less than 10 mm beyond the circumflex with no distal appendage or residual leak therefore after left atrial pended angiography to confirm the echo findings no appendage closure was performed
Pre Procedure Diagnosis: Paroxysmal atrial fibrillation
Post Procedure Diagnosis: same
Procedures Performed:
1. Transseptal Left & Right Heart Catheterization
2. Left Atrial Angiography
3.Vascular access using ultrasound
Complications: None, with NO evidence of significant pericardial effusion at the end of the procedure as verified by TEE
Procedure:
The patients presenting rhythm was sinus. The patient was brought to the electrophysiology laboratory in a fasting state. .The patient received preprocedure IV antibiotics.
The transesophageal echo probe had been placed prior to vascular access by the echocardiographer. Baseline imaging revealed No evidence of any leak around the previously implanted lariat. There was a stump however the largest measurements were 10 mm in depth and was borderline criteria whether we could implant a closure device.
I decided we should release to left atrial pended angiography to verify the absence of any other residual anatomic variants.
Right femoral venipuncture was performed using ultrasound access and a long guidewire was advanced up to the SVC. Next the 8.5 French large curl deflectable Jiles sheath transseptal sheath was advanced up to the SVC and t using an NR G needle and transesophageal echo imaging a transseptal puncture was performed and the sheath was advanced to the left side.
A pigtail catheter was placed after measuring pressures in the left atrium and angiography was performed of the left atrial appendage which in orthogonal views confirmed my suspicion that there was no leak into a remnant left atrial appendage and this was a small stump without depth for adequate closure.
The system was removed with careful avoidance of the pacemaker leads and vascular access was closed using a Vascade device and figure-of-eight stopcock/suture.
The patient tolerated the procedure well and left the electrophysiology lab in stable condition.