Rosanat1991
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Can you help us code the following report. I think we are on target, but as we are new to this we'd love some advice. 
Please and Thank you!!!!
The doctor's report states:
.....
Procedure Performed
1. Left brachial acess
2. Aortogram at root
3. Repeat aortogram at the arch
4. Selective left subclavian angiogramx2
5. Selective left internal mammary angiogram
6. Measurement of gradient across left subclavian lesion
7. Manual closure
HISTORY OF PRESENT ILLNESS:
See notes
PROCEDURE:
The patient was brought to the cardiac cath lab where he was prepped and draped in the usual sterile fashion. Micropuncture technique was attempted to insert a 6-French sheath in the left brachial artery.
We gave 5000 units of heparin through the sheath.
A 6-French pigtail was then crossed over into the ascending aorta and positioned at the root and aortogram was performed using 40 cc contrast in AP view. We then used the pigtail at the arch focusing at the left great vessels and performed angiography using 30 cc contrast.
We then used a MP catheter to perform selective angiography of the left subclavian and then measured a gradient using this catheter to pull back across the lesion.
We then exchanged to a JR4 and again performed a selective left subclavian angiography focusing at the lesion. We then could not get the IMA. We exchanged to an IMA and performed angiography of the IMA in a single view.
At the conclusion, all wires, catheters were removed at this point. Manual hemostasis was advised.
Findings:
1. Aortography at the root: normal root without significant AI.
2. Aortography at the arch: patent great vessels with moderate disease in the left subclavian.
3. Left subclavion angiogram: moderate disease in the left subclavian proximally with a 7 mm gradient across the lesion measured.
4. IMA angiography: the IMA is patent without any critical obstructions
IMPRESSION:
1. Known coronary artery disease, better served with surgical revascularization (awaiting and deffered due to renal issues and pulmonary edema).
2. Patent IMA
3. Moderate left subclavian stenosis not yet warranting intervention with mild gradient.
Please and Thank you!!!! The doctor's report states:
.....
Procedure Performed
1. Left brachial acess
2. Aortogram at root
3. Repeat aortogram at the arch
4. Selective left subclavian angiogramx2
5. Selective left internal mammary angiogram
6. Measurement of gradient across left subclavian lesion
7. Manual closure
HISTORY OF PRESENT ILLNESS:
See notes
PROCEDURE:
The patient was brought to the cardiac cath lab where he was prepped and draped in the usual sterile fashion. Micropuncture technique was attempted to insert a 6-French sheath in the left brachial artery.
We gave 5000 units of heparin through the sheath.
A 6-French pigtail was then crossed over into the ascending aorta and positioned at the root and aortogram was performed using 40 cc contrast in AP view. We then used the pigtail at the arch focusing at the left great vessels and performed angiography using 30 cc contrast.
We then used a MP catheter to perform selective angiography of the left subclavian and then measured a gradient using this catheter to pull back across the lesion.
We then exchanged to a JR4 and again performed a selective left subclavian angiography focusing at the lesion. We then could not get the IMA. We exchanged to an IMA and performed angiography of the IMA in a single view.
At the conclusion, all wires, catheters were removed at this point. Manual hemostasis was advised.
Findings:
1. Aortography at the root: normal root without significant AI.
2. Aortography at the arch: patent great vessels with moderate disease in the left subclavian.
3. Left subclavion angiogram: moderate disease in the left subclavian proximally with a 7 mm gradient across the lesion measured.
4. IMA angiography: the IMA is patent without any critical obstructions
IMPRESSION:
1. Known coronary artery disease, better served with surgical revascularization (awaiting and deffered due to renal issues and pulmonary edema).
2. Patent IMA
3. Moderate left subclavian stenosis not yet warranting intervention with mild gradient.