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 SUMMARYSuccessful MitraClip to the A2, P2 valve leaflet segments.Impressions:
Baseline mitral regurgitation of very severe (4+) was reduced to mild to moderate (1+).
Complications: There is a hematoma at the access site (left femoral vein).
Patient was then transferred to the CICU for post-operative management.
MEDICAL (GENERAL) HISTORYSevere Mitral RegurgitationNYHA Class III heart 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.Chest, physical findingsChest examination normalVital 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
Repair of mitral valve using fluoroscopic guidance.
Procedure IndicationsMitral valve regurgitation (with severity = severe)
Procedure AnesthesiaGeneral anesthesia, please see separate anesthesiologist report.Medications Administered09:17 AM Aspirin PO 325 mg delivered prior to general anesthesia
Aspirin PO 325 mg
BayerCommunity Health and HospitalsProcedures6F sheath: Right femoral vein.ProGlide deployed18F DrySeal sheath: Right femoral veinAtrial septal puncture performedMitraClip guiding catheter: Right femoral veinBaseline mitral measurementsMitraClip positioned and deployed in the A2-P2 positionPostprocedure mitral valve assessment by ultrasoundMitraClip delivery system removed over wirePerclose x2 deployed: right femoral arteryRepair of mitral valve using fluoroscopic guidanceProcedure Specimens TakenNonePROCEDURE DISPOSITIONThe patient was taken to the CICU Recovery Unit in stable condition.TAVR Procedure ResultsHemodynamics: BaselineMitral Regurgitation: SevereMitral Valve Median Gradient: 2 mmHGLeft Atrial Mean Pressure: 19 mmHgMitral Inflow Gradient: 2 mmHg Cardiac Output: 3.1 L/minHemodynamics: post-mitral valve clip deploymentMitral Regurgitation: Trace to Mild (1+)Mitral Valve Median Gradient: 2 mmHgLeft atrial mean pressure: 17 mmHgMitral Inflow Gradient: 2 mmHgCardiac Output: 5.9 L/minBaseline Mitral Regurgitation: SevereBaseline Mitral Valve Median Gradient: 2 mmHgBaseline Left Atrial Mean Pressure: 19 mmHgBaseline Mitral Inflow Gradient: 2 mmHgBaseline Cardiac Output: 3.1 L/minPost-Procedure Mitral Regurgitation: MildPost-Procedure Mitral Valve Median Gradient: 2 mmHgPost-Procedure Left Atrial Mean Pressure: 19 mmHgPost-Procedure Mitral Inflow Gradient: 2 mmHgPost-Procedure Cardiac Output: 5.9 L/minComplicationsHematoma at access sitePostoperative hematoma formationPostprocedure DiagnosisMitral valve regurgitation with mild severityPlan of Care
Transfer patient to CICU for post-operative management.