MHATRAINING
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Postoperative Information
Procedure:
1. MODERATE IV SEDATION AND MONITORING
2. LEFT HEART CATHETERIZATION
3. CORONARY ANGIOGRAM
4. LEFT VENTRICULAR ANGIOGRAM
5. AORTIC ARCH ANGIOGRAM
6. ABDOMINAL AORTA ANGIOGRAM WITH RUNOFFS
7. LIMA ANGIOGRAM
8. MYNX CLOSURE
Preoperative Diagnosis: Abnormal stress test (ICD10-CM R94.39, Discharge, Medical), Exertional angina (ICD10-CM I20.89,
Discharge, Medical), Systolic and diastolic CHF, chronic
(ICD10-CM I50.42, Discharge, Medical), PAD (peripheral artery disease) (ICD10-CM I73.9, Discharge, Medical), CAD
(coronary artery disease) (ICD10-CM I25.10, Discharge, Medical).
Postoperative Diagnosis: Same, 3V NATIVE CAD WITH PATENT LIMA GRAFT, MODERATE-SEVERE ILIAC AND
FEMORAL ARTERY DISEASE WITH LEFT COMMON ILIAC CTO.
Performed by:
Assistant: N/A.
Anesthesiologist: N/A.
Findings: AFTER THE RISK, BENEFITS, AND ALTERNATIVES TO CARDIAC CATHETERIZATION WERE
EXPLAINED IN DETAIL TO THE PATIENT, INFORMED CONSENT WAS OBTAINED. THE PATIENT WAS BROUGHT
TO
THE CATH LAB AND PREPPED AND DRAPED IN THE USUAL FASHION.
MODERATE IV SEDATION WAS ADMINISTERED WHILE THE PATIENT WAS MONITORED CLOSELY.
AFTER 1% LIDOCAINE WAS ADMINISTERED FOR LOCAL ANESTHESIA, A MICROPUNCTURE TECHNIQUE WAS
USED TO ACCESS THE FEMORAL ARTERY AND A 6 FR SHEATH WAS INSERTED. THE JL4/JR4 CATHETERS
WERE USED TO SELECTIVELY CANNULATE THE CORONARY ARTERIES AND LEFT VENTRICLE AND OBTAIN
ANGIOGRAPHIC IMPAGES AND HEMODYNAMIC MEASUREMENTS.
A PIGTAIL CATHETER WAS USED TO OBTAIN ANGIOGRAM IMAGES OF THE INFRARENAL ABDOMINAL
AORTA AND BILATERAL ILIAC AND FEMORAL ARTERIES.
AFTER THE CARDIAC PROCEDURE WAS COMPLETED, A MYNX DEVICE WAS USED TO ACHIEVE HEMOSTASIS.
THE PATIENT TOLERATED THE PROCEDURE WELL AND WAS TRANSFERRED TO THE RECOVERY ROOM IN
STABLE CONDITION.
MODERATE CONSCIOUS SEDATION TIME: 56 MINUTES
HEMODYNAMICS: AORTA 126/63 mmHg, MEAN Ao 89 mmHg, LVEDP 33 mmHg.
FINDINGS:
LM: LARGE, MILD PROXIMAL DISEASE
LAD: MODERATE SIZE, MID 90% LESION WITH COMPETETIVE FLOW IN MID LAD, DISTAL VESSEL HAS MILD
IRREGULARITIES AND FILLS VIA LIMA GRAFT
LCX: NON-DOMINANT, MODERATE SIZE, MILD TO MODERATE DIFFUSE DISEASE IN LCX AND OMs, DISTAL
VESSEL PROVIDES COLLATERALS TO RCA
RCA: DOMINANT, PROXIMAL CTO, DISTAL VESSELS FILL VIA COLLATERALS FROM LEFT SYSTEM
LEFT VENTRICLE: EF 20-25%
AORTIC ARCH: MILDLY DILATED BUT NO SIGNIFICANT DISEASE, ANEURYSM OR DISSECTION NOTED.
ABDOMINAL AORTA: MODERATE DIFFUSE DISEASE
RIGHT ILIAC ARTERY: OSTIAL 40% LESION WITH MODERATE DIFFUSE DISEASE
RIGHT FEMORAL ARTERY: MODERATE TO SEVERE DIFFUSE DISEASE
LEFT ILIAC ARTERY: COMMON ILIAC ARTERY HAS DISTAL CTO
IMPRESSION:
1. 3V NATIVE CAD WITH PATENT LIMA GRAFT, MODERATE-SEVERE ILIAC AND FEMORAL ARTERY DISEASE
WITH LEFT COMMON ILIAC CTO
2. LEFT COMMON ILIAC WITH DISTAL CTO
3. MODERATE TO SEVERE RIGHT FEMORAL ARTERY DISEASE
4. MODERATE DIFFUSE DISEASE OF THE ABDOMINAL AORTA
5. EF 20-25%
PLAN:
1. OPTIMAL MEDICAL MANAGEMENT OF KNOWN CAD AND PAD.
2. FOLLOW UP FOR PAD.
3. REFER FOR CRT-ICD IMPLANTATION.
4. F/U AS OUTPATIENT.
***
*.
Postoperative Information
Procedure:
1. MODERATE IV SEDATION AND MONITORING
2. LEFT HEART CATHETERIZATION
3. CORONARY ANGIOGRAM
4. LEFT VENTRICULAR ANGIOGRAM
5. AORTIC ARCH ANGIOGRAM
6. ABDOMINAL AORTA ANGIOGRAM WITH RUNOFFS
7. LIMA ANGIOGRAM
8. MYNX CLOSURE
Preoperative Diagnosis: Abnormal stress test (ICD10-CM R94.39, Discharge, Medical), Exertional angina (ICD10-CM I20.89,
Discharge, Medical), Systolic and diastolic CHF, chronic
(ICD10-CM I50.42, Discharge, Medical), PAD (peripheral artery disease) (ICD10-CM I73.9, Discharge, Medical), CAD
(coronary artery disease) (ICD10-CM I25.10, Discharge, Medical).
Postoperative Diagnosis: Same, 3V NATIVE CAD WITH PATENT LIMA GRAFT, MODERATE-SEVERE ILIAC AND
FEMORAL ARTERY DISEASE WITH LEFT COMMON ILIAC CTO.
Performed by:
Assistant: N/A.
Anesthesiologist: N/A.
Findings: AFTER THE RISK, BENEFITS, AND ALTERNATIVES TO CARDIAC CATHETERIZATION WERE
EXPLAINED IN DETAIL TO THE PATIENT, INFORMED CONSENT WAS OBTAINED. THE PATIENT WAS BROUGHT
TO
THE CATH LAB AND PREPPED AND DRAPED IN THE USUAL FASHION.
MODERATE IV SEDATION WAS ADMINISTERED WHILE THE PATIENT WAS MONITORED CLOSELY.
AFTER 1% LIDOCAINE WAS ADMINISTERED FOR LOCAL ANESTHESIA, A MICROPUNCTURE TECHNIQUE WAS
USED TO ACCESS THE FEMORAL ARTERY AND A 6 FR SHEATH WAS INSERTED. THE JL4/JR4 CATHETERS
WERE USED TO SELECTIVELY CANNULATE THE CORONARY ARTERIES AND LEFT VENTRICLE AND OBTAIN
ANGIOGRAPHIC IMPAGES AND HEMODYNAMIC MEASUREMENTS.
A PIGTAIL CATHETER WAS USED TO OBTAIN ANGIOGRAM IMAGES OF THE INFRARENAL ABDOMINAL
AORTA AND BILATERAL ILIAC AND FEMORAL ARTERIES.
AFTER THE CARDIAC PROCEDURE WAS COMPLETED, A MYNX DEVICE WAS USED TO ACHIEVE HEMOSTASIS.
THE PATIENT TOLERATED THE PROCEDURE WELL AND WAS TRANSFERRED TO THE RECOVERY ROOM IN
STABLE CONDITION.
MODERATE CONSCIOUS SEDATION TIME: 56 MINUTES
HEMODYNAMICS: AORTA 126/63 mmHg, MEAN Ao 89 mmHg, LVEDP 33 mmHg.
FINDINGS:
LM: LARGE, MILD PROXIMAL DISEASE
LAD: MODERATE SIZE, MID 90% LESION WITH COMPETETIVE FLOW IN MID LAD, DISTAL VESSEL HAS MILD
IRREGULARITIES AND FILLS VIA LIMA GRAFT
LCX: NON-DOMINANT, MODERATE SIZE, MILD TO MODERATE DIFFUSE DISEASE IN LCX AND OMs, DISTAL
VESSEL PROVIDES COLLATERALS TO RCA
RCA: DOMINANT, PROXIMAL CTO, DISTAL VESSELS FILL VIA COLLATERALS FROM LEFT SYSTEM
LEFT VENTRICLE: EF 20-25%
AORTIC ARCH: MILDLY DILATED BUT NO SIGNIFICANT DISEASE, ANEURYSM OR DISSECTION NOTED.
ABDOMINAL AORTA: MODERATE DIFFUSE DISEASE
RIGHT ILIAC ARTERY: OSTIAL 40% LESION WITH MODERATE DIFFUSE DISEASE
RIGHT FEMORAL ARTERY: MODERATE TO SEVERE DIFFUSE DISEASE
LEFT ILIAC ARTERY: COMMON ILIAC ARTERY HAS DISTAL CTO
IMPRESSION:
1. 3V NATIVE CAD WITH PATENT LIMA GRAFT, MODERATE-SEVERE ILIAC AND FEMORAL ARTERY DISEASE
WITH LEFT COMMON ILIAC CTO
2. LEFT COMMON ILIAC WITH DISTAL CTO
3. MODERATE TO SEVERE RIGHT FEMORAL ARTERY DISEASE
4. MODERATE DIFFUSE DISEASE OF THE ABDOMINAL AORTA
5. EF 20-25%
PLAN:
1. OPTIMAL MEDICAL MANAGEMENT OF KNOWN CAD AND PAD.
2. FOLLOW UP FOR PAD.
3. REFER FOR CRT-ICD IMPLANTATION.
4. F/U AS OUTPATIENT.
***
*.
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