Right and Left Heart Catheterization, Selective Coronary Angiography, and Left $\quad$

question 65

Short Answer

Right and left heart catheterization, selective coronary angiography, and left ventriculogram.
The patient was prepped and draped in the usual sterile fashion and sedation was administered for a total of fentanyl, 25 mcg IV, and Versed, 0.5 mg IV.One percent lidocaine was infused in the right groin and a 7-French sheath was inserted in the right femoral artery.A 7-French Swan-Ganz catheter was advanced through the right heart chambers and into the pulmonary artery.After pulmonary capillary wedge pressure and pulmonary artery pressures were obtained, thermodilution cardiac outputs were measured.The Swan-Ganz catheter was then pulled back to the right heart chambers prior to removal.Selective coronary angiography was then performed.A 6-French JL4 catheter was used for selective angiography of the left coronary artery and right coronary artery.A 6-French pigtail catheter was used for RAO left ventriculogram using a hand injection.Following the procedure, the sheaths were removed and hemostasis was achieved using VasoSeal.The patient tolerated the procedure well without complications.
RIGHT HEART CATHETERIZATION: The right heart pressures were as follows: The mean pulmonary capillary wedge pressure was 10 mm Hg.The pulmonary artery pressures were 37/17 with a mean of 20 mm Hg.The right ventricular pressure was 34/2 and the mean right atrial pressure was 5 mm Hg.The mean cardiac output was 4.2 L per minute.
LEFT HEART CATHETERIZATION: The left main coronary artery appeared calcified.There was no obstructive disease observed.The left anterior descending artery was also calcified in its ostial and proximal portions.There was mild luminal irregularity noted in the proximal and mid portions of the vessel.Two moderate size diagonal branches were observed without high-grade disease.The mid LAD contained a 40%-50% narrowing.The remaining distal vessel appeared free of disease.The circumflex vessel was a large vessel.There was a 60% focal lesion in the proximal portion of this artery.There was some ectasia noted also in the proximal portion of the vessel.A large obtuse marginal branch was observed which appeared free of high-grade disease.The right coronary artery was 100% occluded in its proximal portion.The distal vessel filled via left-to-right collaterals from the LAD and circumflex system.
VENTRICULOGRAM: The left ventriculogram showed good LV systolic function with an ejection fraction of 60%.No wall motion abnormalities were noted.The left ventricular end diastolic pressure was 7-8 mm Hg.
IMPRESSION: $\quad$ 1. Mild-to-moderate IAD and circurnflex disease
$\quad$$\quad$$\quad$$\quad$$\quad$$\quad$ 2. Occluded proximal right coronary artery, presurnably chronic
$\quad$$\quad$$\quad$$\quad$$\quad$$\quad$ 3. Good LV systolic function.
$\quad$$\quad$$\quad$$\quad$$\quad$$\quad$ 4. Nommal ripht heart pressures
(Separate the codes with a comma in your response as follows: XXXXX, XXXXX.)
Right and left heart catheterization CPT code: ____________________

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