Procedures
Right heart catheterization, left heart catheterization, coronary angiography, left ventriculography and central venography.
Indication
Dyspnea, abnormal nuclear stress imaging with inferoapical ischemia
Clinical
Mr. Smith is a 70-year-old male with 3 months of increasing shortness of breath on exertion, tis was fairly sudden onset. He has been diagnosed via CT with honeycombing suggesting pulmonary fibrosis, moderate-to-severe pulmonary hypertension on echo estimation, preserved LV function with abnormal nuclear stress imaging as above. Right and left heart catheterization was recommended by his cardiologist in Greenwood. Subsequently, he sought a second opinion and saw Dr.Nawabi. Dr.Nawabi recommended the same. He does have a history of recurrent DVT and pulmonary emboli and is on chronic Coumadin. I was asked to perform the procedure.
Procedure In Detail
After informed consent was obtained, the patient was brought to the cath lab, prepped and draped in the usual sterile fashion. Lidocaine was used for local anesthesia and Versed for sedation. Seldinger technique was used to cannulate the right femoral vein and place a 7-French venous sheath. With some difficulty due to some mild-to-moderate stenosis in the right iliac vein and with the use of a Swan wire, the Swan-Ganz catheter was gently inserted to the region of the IVC filter. It was deiced previously given the patients pulmonary fibrosis and chronic coughing that attempted internal jugular or subclavian venous cannulation without general anesthesia would be difficult and potentially dangerous. Subsequently, we attempted to pass the probe and the Swan-Ganz catheter beyond the IVC filter. Unfortunately, the IVC was completely occluded with collateral flow around the IVC Filter. Venography was performed in this region. Subsequently, attempts were abandoned, the central venous pressure was obtained and subsequently, the Swan-Ganz catheter was removed. Seldinger technique was then used to cannulate the right femoral artery and place a 5-French arterial sheath. JL4 and 3D RC catheters were used for selective coronary angiography. A pigtail catheter was then advanced to the left ventricle for hemodynamic monitoring and left ventriculography. Following the procedure, catheters and sheaths were removed and hemostasis was obtained using manual compression.
the rest of the dictation completes a LHC
how would you code this?
Last edited by kashyatt@aol.com; Today at 03:56 PM.
Reason: not finished
Venogram (IVC) help please
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