trayt01
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LOOKING FOR HELP WITH THE PROPER CPT CODES FOR THE FOLLOWING. I WOULD APPRECIATE ANY HELP! THANK YOU.
PROCEDURES: Coronary angiography, right heart catheterization with thermodilution cardiac output, left ventricular/aortic simultaneous pressure measurement.
PREOPERATIVE DIAGNOSIS: Severe aortic valve stenosis.
POSTOPERATIVE DIAGNOSES:
- Fibrocalcific aortic valve disease with severe stenosis.
- Severe multivessel coronary artery disease.
TECHNIQUE: The patient was admitted to the CVL Laboratory with preparation of both the right and left femoral regions sterilely. Following the administration of 1% lidocaine, the right and left femoral arteries were percutaneously cannulated with introduction of 5 French sheaths respectively. The right femoral vein was percutaneously cannulated with placement of a 7 French short introducer sheath. Right heart catheterization was performed under combination of fluoroscopic and pressure guidance. Thermodilution cardiac outputs were obtained. The Swan-Ganz catheter was then withdrawn with measurement of right ventricular and right atrial pressures. Selective coronary angiography was completed in multiple projections utilizing preformed catheters. Pigtail catheters were then inserted through both femoral artery sheaths and positioned in the ascending aorta. Simultaneous pressures were recorded demonstrating excellent correlation between the 2 pressures. A single pigtail catheter was then advanced across the aortic valve with the assistance of a stiff angled Glidewire. Simultaneous LV and aortic pressures were recorded. Contrast left ventriculography was not performed due to previous echocardiographic confirmation of normal left ventricular systolic function. The pigtail catheter was withdrawn from the ventricle with simultaneous aortic pressure recording. Following completion of the procedure, all vascular appliances were removed and firm pressure applied until hemostasis was obtained. The patient tolerated the procedure without complication.
HEMODYNAMICS: Right atrial mean 5, right ventricular pressure 46/3. Pulmonary artery pressure 43/14, mean 26. Pulmonary capillary wedge mean 18. Left ventricular pressure 204/5, aortic pressure 165/56, the mean of 95. Thermodilution cardiac output 3.75 liters per minute. Mean aortic valve gradient of 43, calculated aortic valve area 0.7 cm2.
IMAGES
RIGHT CORONARY: The right coronary artery is dominant, but occluded in the mid vessel.
LEFT CORONARY: The left main coronary artery is normal in appearance bifurcating into the LAD and circumflex systems. The proximal left anterior descending coronary artery demonstrates focal high-grade stenosis estimated at 90%. Associated coronary calcification is present. The middle and distal portions of the LAD appear unobstructed with a vessel diameter in excess of 2-2.5 mm. The major diagonal also demonstrates a high-grade proximal obstruction. The circumflex coronary artery distally demonstrates high-grade focal obstruction involving the distal posterolateral division. There is evidence of left to right collateralization of the posterior descending coronary artery division.
LEFT VENTRICULOGRAM: Not performed.
FINAL IMPRESSION: Severe aortic valve stenosis with multivessel coronary artery disease.
RECOMMENDATIONS: The patient will be referred for aortic valve replacement in conjunction with bypass revascularization. Future care will emphasize appropriate risk factor intervention efforts.
PROCEDURES: Coronary angiography, right heart catheterization with thermodilution cardiac output, left ventricular/aortic simultaneous pressure measurement.
PREOPERATIVE DIAGNOSIS: Severe aortic valve stenosis.
POSTOPERATIVE DIAGNOSES:
- Fibrocalcific aortic valve disease with severe stenosis.
- Severe multivessel coronary artery disease.
TECHNIQUE: The patient was admitted to the CVL Laboratory with preparation of both the right and left femoral regions sterilely. Following the administration of 1% lidocaine, the right and left femoral arteries were percutaneously cannulated with introduction of 5 French sheaths respectively. The right femoral vein was percutaneously cannulated with placement of a 7 French short introducer sheath. Right heart catheterization was performed under combination of fluoroscopic and pressure guidance. Thermodilution cardiac outputs were obtained. The Swan-Ganz catheter was then withdrawn with measurement of right ventricular and right atrial pressures. Selective coronary angiography was completed in multiple projections utilizing preformed catheters. Pigtail catheters were then inserted through both femoral artery sheaths and positioned in the ascending aorta. Simultaneous pressures were recorded demonstrating excellent correlation between the 2 pressures. A single pigtail catheter was then advanced across the aortic valve with the assistance of a stiff angled Glidewire. Simultaneous LV and aortic pressures were recorded. Contrast left ventriculography was not performed due to previous echocardiographic confirmation of normal left ventricular systolic function. The pigtail catheter was withdrawn from the ventricle with simultaneous aortic pressure recording. Following completion of the procedure, all vascular appliances were removed and firm pressure applied until hemostasis was obtained. The patient tolerated the procedure without complication.
HEMODYNAMICS: Right atrial mean 5, right ventricular pressure 46/3. Pulmonary artery pressure 43/14, mean 26. Pulmonary capillary wedge mean 18. Left ventricular pressure 204/5, aortic pressure 165/56, the mean of 95. Thermodilution cardiac output 3.75 liters per minute. Mean aortic valve gradient of 43, calculated aortic valve area 0.7 cm2.
IMAGES
RIGHT CORONARY: The right coronary artery is dominant, but occluded in the mid vessel.
LEFT CORONARY: The left main coronary artery is normal in appearance bifurcating into the LAD and circumflex systems. The proximal left anterior descending coronary artery demonstrates focal high-grade stenosis estimated at 90%. Associated coronary calcification is present. The middle and distal portions of the LAD appear unobstructed with a vessel diameter in excess of 2-2.5 mm. The major diagonal also demonstrates a high-grade proximal obstruction. The circumflex coronary artery distally demonstrates high-grade focal obstruction involving the distal posterolateral division. There is evidence of left to right collateralization of the posterior descending coronary artery division.
LEFT VENTRICULOGRAM: Not performed.
FINAL IMPRESSION: Severe aortic valve stenosis with multivessel coronary artery disease.
RECOMMENDATIONS: The patient will be referred for aortic valve replacement in conjunction with bypass revascularization. Future care will emphasize appropriate risk factor intervention efforts.