Cardiac catheterization study report17 Daws Rd.Blue BellMA02368USMr.AdamFrankieEveryman21 North Ave.BurlingtonMA02368USHenrySevenGood Health Clinic17 Daws Rd.Blue BellMA02368US21 North Ave.BurlingtonMA02368USHenrySeven21 North Ave.BurlingtonMA02368USHenrySeven1001 Hospital LaneAnn ArborMI99999USDr.TonyTumReferring Physician Lane, USADr. Referring PhysicianMy Favorite Cardiac Care OrganizationHealthcare LaneEast TownOHUSCATH PROCEDURE SUMMARYA successful TAVR procedure was performed.Impressions:
Severe aortic stenosis status post successful TAVR via a right transfemoral percutaneous approach with a 29mm Sapien S3 value.
Ventricular bradycardia and bundle branch block following valve deployment prompting permanent pacemaker placement.
Patient was then transferred to the CICU for post-operative management.
MEDICAL (GENERAL) HISTORYAortic stenosisHeart failureAortic StenosisHeart failureAllergies The patient has allergies to penicillin based products
Family history No Family History of Cardiovascular DiseaseThere was no family history of cardiovascular disease.Social History
The patient was a former smoker.
PHYSICAL EXAMINATIONAll normal to examination.Vital SignsHeight: 178 cmWeight: 87.7 kgBSA: 2.06 m2Preprocedure Laboratory ResultsSodium [Moles/volume] in Venous blood: 139 mmol/LPotassium [Moles/volume] in Blood: 4.1 mmol/LGlucose: 115 mg/dLBlood urea nitrogen (Bun): 17 mg/dLCreatinine [Mass/volume] in Blood: 0.93 mg/dLWhite Blood Cell Count (WBC): 5.10 10^3/uLHemoglobin (Hgb): 14.7 g/dlHematocrit (HCT): 43 %Platelets: 141 X10^9Prothrombin time (PT): 13.9 secPartial thromboplastin time (PTT): 28International normalized ratio (INR): 1.1Planned Procedure
A TAVR procedure is planned.
Procedure Indications Aortic valve stenosis
Procedure AnesthesiaGeneral anesthesia, please see separate anesthesiologist report.Medications Administered09:17 AM Aspirin PO 325 mg delivered prior to general anesthesiaPlease refer to anesthesiologist report for all other medications
Aspirin PO 325 mg
BayerCommunity Health and HospitalsProcedures6F sheath (pacer): Right femoral vein.Pacing threshold testing performed18F sheath: Right femoral arteryBaseline aortic valve assessment by ultrasound6F pigtail catheter: Right radial artery.Baseline Aortic root angiography performedBaseline left heart catheterization29mm Edwards Sapien THV mounted and advanced and positionedRapid pacing initiatedImplantation of aortic valve prosthesisRapid pacing terminatedPostprocedure aortic valve assessment by ultrasoundValve delivery system removed over wirePostprocedure aortic root angiographyPostprocedure left heart catheterization6F pigtail catheter removedPerclose x2 deployed: right femoral arteryTR band applied to right radial arteryRight femoral artery closure: Perclose suture closure x 2Left femoral vein closure: manual pressureRight radial artery closure: TR BandImplantation of aortic valve prosthesisProcedure Specimens TakenNonePROCEDURE DISPOSITIONThe patient was taken to the CICU Recovery Unit in stable condition.TAVR Procedure ResultsHemodynamics: BaselineLeft ventricular pressure: 141/13 mmHgAortic pressure: 99/59/73 mmHgRight atrial pressure: 12 mmHgPA pressure: 35/19/26 mmHgMean aortic valve gradient: 37 mmHgCardiac Output: 2.3 L/minValve area: 0.39 cm^2Hemodynamics: post-valve insertionLeft ventricular pressure: 138/25 mmHgAortic pressure: 142/73/96 mmHgRight atrial pressure: 18 mmHgPA pressure: 51/27/36 mmHgMean aortic valve gradient: 8 mmHgCardiac Output: 2.3 L/minAortic Valve Area: >2.0 cm^2Baseline Left ventricular systolic pressure: 141 mmHgBaseline Left ventricular diastolic pressure: 13 mmHgBaseline Systolic Aortic pressure: 99 mmHgBaseline Mean Aortic pressure: 73 mmHgBaseline Diastolic Aortic pressure: 59 mmHgBaseline Mean Right atrial pressure: 12 mmHgBaseline Systolic PA pressure: 35 mmHgBaseline Mean PA pressure: 26 mmHgBaseline Diastolic PA pressure: 19 mmHgBaseline Mean aortic valve gradient: 37 mmHgBaseline Cardiac Output: 2.3 L/minBaseline Valve area: 0.39 cm^2Post-Procedure Left ventricular systolic pressure: 138 mmHgPost-Procedure Left ventricular diastolic pressure: 25 mmHgPost-Procedure Systolic Aortic pressure: 142 mmHgPost-Procedure Mean Aortic pressure: 96 mmHgPost-Procedure Diastolic Aortic pressure: 73 mmHgPost-Procedure Mean Right atrial pressure: 18 mmHgPost-Procedure Systolic PA pressure: 51 mmHgPost-Procedure PA Mean pressure: 36 mmHgPost-Procedure PA Diastolic pressure: 27 mmHgPost-Procedure Mean aortic valve gradient: 8 mmHgPost-Procedure Cardiac Output: 2.3 L/minPost-Procedure Valve area: 2.00 cm^2ComplicationsBradycardiaBundle branch blockBradycardiaBundle branch block.Postprocedure DiagnosisAortic StenosisPercutaneous insertion of aortic valve using fluoroscopic guidanceBradycardiaBundle branch blockPlan of Care
Transfer patient to CICU for post-operative management.