DIAGNOSIS: Wolff-Parkinson-White with palpitations NAME OF PROCEDURE: EP study and…

DIAGNOSIS: Wolff-Parkinson-White with palpitations NAME OF PROCEDURE: EP study and Ablation DESCRIPTION OF PROCEDURE: The patient was prepped and draped in a sterile fashion and a time out was performed. Local anesthetic was given in bilateral groins and access was obtained using a modified Seldinger technique to place an 8 Fr and 7 Fr sheathes in the RFV and a 6 Fr and two 5 Fr sheathes in the LFV. An EPS was performed demonstrating no inducible SVT. A 4 mm tip D/F curve Biosense catheter was used to map. Mapping in atrial pacing and sinus showed earliest antegrade activation in a right posteroseptal location along the anterior rim of the CS os. With multiple lesions there was loss of preexcitation but then would come back within a minute. Stability was a question so the catheter was exchanged for a D/F 3.5 mm tip ThermoCool SmarTouch catheter. With 30 W of power and contact of 15–20 g of force there was loss of preexcitation at 5 seconds. Following the second lesion in the same location there was noted to be change in surface QRS with ST elevation. With serial ECG, there was resolution of the changes within 10 minutes back to normal. Given the ST changes I asked Dr. X to come to the lab to do selective coronary angiography and this demonstrated a near occlusion of the left circumflex in the area of the ablation. Dr. X intervened on the coronary with balloon and stent. There was no recurrence of WPW. AV conduction was normal and ECG was normal with mild 1/2 mm ST depression in the inferior leads. NAME OF PROCEDURE: Coronary angiogram and coronary artery balloon angioplasty and stenting. I was called in to assess the patient’s coronary arteries given his EKG changes indicating ST elevation for approximately 10 minutes. At the time of assessment by me, there were no ST changes noted and the blood pressure is ­completely stable 100 to 110 range. 4 French sheath was placed in the right femoral artery. Through the sheath 4 French 1.5 JL catheter was utilized and angiograms were taken in the left coronary artery. It was noted that there was coronary occlusion in the circumflex area. DESCRIPTION OF PROCEDURE: Multiple angiograms were taken utilizing Optiray and a 6 French JL catheter. A 0.014 Forte wire was then utilized to traverse the stenotic area and multiple balloon dilations were performed utilizing 1.5, 1.75, 2, 2.25 coronary balloon. The patient then had a stent placed utilizing a bare-metal coronary stent and 2.5 mm balloon inflated to 20 atmospheres. Post stent placement angiogram demonstrates a normal perfusion to the coronary arteries. DESCRIPTION OF ANGIOGRAMS: LEFT CORONARY ANGIOGRAM: Injection into the left coronary demonstrates normal ostium with no stenosis of the left coronary artery system with a normal flow in the left anterior descending coronary artery. Assign ICD-10-PCS code(s) to the following case studies: