sandy06
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PREOPERATIVE DIAGNOSES:
1. Critical aortic stenosis, inoperable surgical candidate.
2. Coronary artery disease.
POSTOPERATIVE DIAGNOSES:
1. Critical aortic stenosis, inoperable surgical candidate.
2. Coronary artery disease.
OPERATING SURGEON:
. M.D.
OPERATING INTERVENTIONAL CARDIOLOGIST:
, M.D.
PROCEDURE PERFORMED:
1. February 4, 2013: Transcatheter aortic valve replacement, utilizing
a 29 mm core valve.
2. Right femoral artery cutdown and exposure of the femoral artery and
direct repair of the femoral artery.
3. Right femoral angiogram and iliac artery angiogram.
4. Ascending aortic aortography.
5. Aortic balloon valvuloplasty and left heart catheterization, and
transfemoral right ventricular pacing. Also, implantation of
transvenous subclavian temporary pacing wire.
DESCRIPTION OF PROCEDURE:
The patient was taken to the Hybrid suite in the cardiac
catheterization lab and placed in the supine position and placed under
general anesthesia, and then prepped and draped in the usual fashion
for a transcatheter aortic valve replacement. The operation initiated
with obtaining access of the right femoral artery and vein utilizing a
6-French sheath and dilator, and thereafter a transvenous temporary
pacing wire was inserted into the right ventricle, which would be
utilized for later rapid ventricular pacing during the aortic balloon
valvuloplasty. Through the arterial sheath, a 6-French pigtail
catheter was inserted into the noncoronary cusp, which would aide in
assessment of the level of the annulus for implantation of the core
valve. Thereafter, the left femoral artery was exposed with a
longitudinal incision in the suprainguinal region. The incision was
taken down through skin and subcutaneous tissues, and exposing the
femoral artery. Both proximal and distal control of femoral artery
were obtained, and then at this point, the patient was heparinized and
a arteriotomy was performed and a 18-French Cook catheter was passed
onto the operative field, and a wire was passed into the catheter, and
this was a 30 cm long catheter, and then once the arteriotomy was
performed, this was introduced into the femoral artery and advanced
into the proximal iliac/aorta. Confirmation was obtained utilizing
fluoroscopy and thereafter, through this Cook catheter sheath, a JR4
catheter was inserted and then this was placed up against the stenotic
valve and crossed with a 260 exchange wire. Thereafter, a pigtail
catheter was advanced into the left ventricle and dual differential
pressures were obtained. Once the hemodynamics were assessed at this
point, a ST1 260 stiff Amplatz wire was advanced in a retrograde
fashion into the left ventricle, and thereafter, a 20 mm balloon was
passed over the wire and rapid ventricular pacing was instituted, and
a balloon aortic valvuloplasty was performed. At this point, a 29 mm
core valve was placed into the delivery system and passed over the
wire and then over this Amplatz wire position in the aorta. Multiple
aortic angiograms were obtained and once adequate positioning was
noted, the transcatheter valve was then released, and then prior to
release, an angiogram was performed to confirm placement, and then the
valve was finally released, and then the delivery system was removed,
and then removed from the femoral sheath, as well. The stiff wire was
exchanged for a pigtail catheter, and then the other pigtail catheter,
which was in the aortic root was placed above or into the core valve
and simultaneous pressures were assessed and there was a minimal
gradient across aortic valve with mild aortic insufficiency. At this
point, the catheters were removed and then, in addition to the femoral
sheath in a two layer closure, the femoral artery was performed with a
5-0 Prolene suture in a continuous over-and-over fashion. Thereafter,
an angiogram was performed to assess that there was no stenosis of the
iliac artery. Thereafter, a left femoral left subclavian venous access
was obtained, and a temporary transvenous pacing wire was inserted, in
the event that and an arterial venous block were to recur in the
perioperative. The patient tolerated procedure well. No complication
encountered.
Hi! Just need some confirmation of how to code for the TAVR I came up with 33362
, but I'm trying to figure out if everything is included in this one code or how should go about coding it. Please give send me some insight on how to code this report.
Thanks in advance
1. Critical aortic stenosis, inoperable surgical candidate.
2. Coronary artery disease.
POSTOPERATIVE DIAGNOSES:
1. Critical aortic stenosis, inoperable surgical candidate.
2. Coronary artery disease.
OPERATING SURGEON:
. M.D.
OPERATING INTERVENTIONAL CARDIOLOGIST:
, M.D.
PROCEDURE PERFORMED:
1. February 4, 2013: Transcatheter aortic valve replacement, utilizing
a 29 mm core valve.
2. Right femoral artery cutdown and exposure of the femoral artery and
direct repair of the femoral artery.
3. Right femoral angiogram and iliac artery angiogram.
4. Ascending aortic aortography.
5. Aortic balloon valvuloplasty and left heart catheterization, and
transfemoral right ventricular pacing. Also, implantation of
transvenous subclavian temporary pacing wire.
DESCRIPTION OF PROCEDURE:
The patient was taken to the Hybrid suite in the cardiac
catheterization lab and placed in the supine position and placed under
general anesthesia, and then prepped and draped in the usual fashion
for a transcatheter aortic valve replacement. The operation initiated
with obtaining access of the right femoral artery and vein utilizing a
6-French sheath and dilator, and thereafter a transvenous temporary
pacing wire was inserted into the right ventricle, which would be
utilized for later rapid ventricular pacing during the aortic balloon
valvuloplasty. Through the arterial sheath, a 6-French pigtail
catheter was inserted into the noncoronary cusp, which would aide in
assessment of the level of the annulus for implantation of the core
valve. Thereafter, the left femoral artery was exposed with a
longitudinal incision in the suprainguinal region. The incision was
taken down through skin and subcutaneous tissues, and exposing the
femoral artery. Both proximal and distal control of femoral artery
were obtained, and then at this point, the patient was heparinized and
a arteriotomy was performed and a 18-French Cook catheter was passed
onto the operative field, and a wire was passed into the catheter, and
this was a 30 cm long catheter, and then once the arteriotomy was
performed, this was introduced into the femoral artery and advanced
into the proximal iliac/aorta. Confirmation was obtained utilizing
fluoroscopy and thereafter, through this Cook catheter sheath, a JR4
catheter was inserted and then this was placed up against the stenotic
valve and crossed with a 260 exchange wire. Thereafter, a pigtail
catheter was advanced into the left ventricle and dual differential
pressures were obtained. Once the hemodynamics were assessed at this
point, a ST1 260 stiff Amplatz wire was advanced in a retrograde
fashion into the left ventricle, and thereafter, a 20 mm balloon was
passed over the wire and rapid ventricular pacing was instituted, and
a balloon aortic valvuloplasty was performed. At this point, a 29 mm
core valve was placed into the delivery system and passed over the
wire and then over this Amplatz wire position in the aorta. Multiple
aortic angiograms were obtained and once adequate positioning was
noted, the transcatheter valve was then released, and then prior to
release, an angiogram was performed to confirm placement, and then the
valve was finally released, and then the delivery system was removed,
and then removed from the femoral sheath, as well. The stiff wire was
exchanged for a pigtail catheter, and then the other pigtail catheter,
which was in the aortic root was placed above or into the core valve
and simultaneous pressures were assessed and there was a minimal
gradient across aortic valve with mild aortic insufficiency. At this
point, the catheters were removed and then, in addition to the femoral
sheath in a two layer closure, the femoral artery was performed with a
5-0 Prolene suture in a continuous over-and-over fashion. Thereafter,
an angiogram was performed to assess that there was no stenosis of the
iliac artery. Thereafter, a left femoral left subclavian venous access
was obtained, and a temporary transvenous pacing wire was inserted, in
the event that and an arterial venous block were to recur in the
perioperative. The patient tolerated procedure well. No complication
encountered.
Hi! Just need some confirmation of how to code for the TAVR I came up with 33362
, but I'm trying to figure out if everything is included in this one code or how should go about coding it. Please give send me some insight on how to code this report. Thanks in advance