csorensen21@yahoo.com
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Am I able to separately code the subclavian angio with 93458???
PROCEDURES:
1. Left heart catheterization.
2. Left ventriculogram.
3. Left subclavian angiography.
4. Right iliac angiography.
5. Consultation to cardiothoracic surgery.
OPERATOR:
PRIMARY CARE PHYSICIAN:
INDICATION: Ongoing stuttering angina with abnormal stress test
with large inferolateral ischemia and LV dilatation.
DESCRIPTION OF PROCEDURE: The patient was consented. Timeout was performed. Risks and benefits were discussed with the patient.
Attempted to access right femoral artery, required a couple of sticks due
to inability to advance wire, then 6-French sheath was advanced and
diagnostic Judkins right was advanced across the aortic valve, directed
into the left atrium. We measured left atrial pressures and then
measured left ventricular diastolic pressure, and hand injection; left
ventriculogram was performed and a pullback was performed. Then,
subsequently, engaged with the right coronary artery, and every time we
engaged, there was significant dampening of pressure, and 2 angiographic
images were performed and then a pullback was performed. Then,
subsequently, we used a Judkins left catheter that engaged with the left
main. Upon engaging with the left main, significant ventricularization of pressure with 50 mm drop in pressure and no flux of contrast backwards. Angiographic images were performed of the left system, then a pullback was performed. Then, diagnostic right was directed into the left subclavian and performed hand injection of the left subclavian artery to confirm
patency of the subclavian and the LIMA, and then the Judkins
right was pulled across the aorta and we did a pullback across the right
common iliac artery with 30 mmHg difference across, but there was 30% to
40% in-stent restenosis in external iliac artery and severe stenosis
in the right common femoral artery of at least 60% stenosis.
FINDINGS: As following:
1. Left ventricle ejection fraction hyperdynamic with ejection
fraction of 80%. Normal left ventricular end-diastolic pressure and
normal left atrial pressure of 6 mmHg.
2. Left main ostial 60% with no retrograde flow and significant
dampening of pressure 30 mmHG .
3. Left anterior descending, heavily calcified vessel, tortuous,
with 50% mid left anterior descending stenosis.
4. Circumflex artery, moderate sized vessel with moderate
distribution. There are 90% lesions proximal and mid, heavily calcified and
tortuous.
5. Right coronary artery, large dominant vessel. Proximally has
a 60% lesion, 50% proximal to mid stent and subtotal in the
posterolateral branch. Right posterior descending artery within normal limits.
6. Patent left subclavian artery.
7. Patent right common iliac artery and patent right external iliac stent
with 30% to 40% stenosis and 15 mm gradient across the iliac
artery, 60% to right common femoral artery.
RECOMMENDATION: Consultation for cardiothoracic surgery for CABG
and risk factor modification.
PROCEDURES:
1. Left heart catheterization.
2. Left ventriculogram.
3. Left subclavian angiography.
4. Right iliac angiography.
5. Consultation to cardiothoracic surgery.
OPERATOR:
PRIMARY CARE PHYSICIAN:
INDICATION: Ongoing stuttering angina with abnormal stress test
with large inferolateral ischemia and LV dilatation.
DESCRIPTION OF PROCEDURE: The patient was consented. Timeout was performed. Risks and benefits were discussed with the patient.
Attempted to access right femoral artery, required a couple of sticks due
to inability to advance wire, then 6-French sheath was advanced and
diagnostic Judkins right was advanced across the aortic valve, directed
into the left atrium. We measured left atrial pressures and then
measured left ventricular diastolic pressure, and hand injection; left
ventriculogram was performed and a pullback was performed. Then,
subsequently, engaged with the right coronary artery, and every time we
engaged, there was significant dampening of pressure, and 2 angiographic
images were performed and then a pullback was performed. Then,
subsequently, we used a Judkins left catheter that engaged with the left
main. Upon engaging with the left main, significant ventricularization of pressure with 50 mm drop in pressure and no flux of contrast backwards. Angiographic images were performed of the left system, then a pullback was performed. Then, diagnostic right was directed into the left subclavian and performed hand injection of the left subclavian artery to confirm
patency of the subclavian and the LIMA, and then the Judkins
right was pulled across the aorta and we did a pullback across the right
common iliac artery with 30 mmHg difference across, but there was 30% to
40% in-stent restenosis in external iliac artery and severe stenosis
in the right common femoral artery of at least 60% stenosis.
FINDINGS: As following:
1. Left ventricle ejection fraction hyperdynamic with ejection
fraction of 80%. Normal left ventricular end-diastolic pressure and
normal left atrial pressure of 6 mmHg.
2. Left main ostial 60% with no retrograde flow and significant
dampening of pressure 30 mmHG .
3. Left anterior descending, heavily calcified vessel, tortuous,
with 50% mid left anterior descending stenosis.
4. Circumflex artery, moderate sized vessel with moderate
distribution. There are 90% lesions proximal and mid, heavily calcified and
tortuous.
5. Right coronary artery, large dominant vessel. Proximally has
a 60% lesion, 50% proximal to mid stent and subtotal in the
posterolateral branch. Right posterior descending artery within normal limits.
6. Patent left subclavian artery.
7. Patent right common iliac artery and patent right external iliac stent
with 30% to 40% stenosis and 15 mm gradient across the iliac
artery, 60% to right common femoral artery.
RECOMMENDATION: Consultation for cardiothoracic surgery for CABG
and risk factor modification.