DOCSLIB.ORG

Surgical Treatment of Giant Saphenous Vein Graft Aneurysm: a Case Report

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Surgical Treatment of Giant Saphenous Vein Graft Aneurysm: a Case Report Successful Surgical Treatment of Giant Saphenous Vein Graft Aneurysm: A Case Report SalahEldien Altarabsheh MD*, Salil Deo MD**, Lyle Joyce MD** ABSTRACT A 72 year-old-male patient who had coronary artery bypass grafting twice in the past, presented with shortness of breath. Coronary angiography showed a giant saphenous vein graft aneurysm, surgical excision of the aneurysm with bypass of the right coronary artery using new vein conduit was performed. The pathophysiology, clinical presentation, diagnostic modalities and therapeutic options will be discussed in light of this case. Key words: Saphenous Vein Graft, Giant Aneurysm, Coronary Artery Bypass Grafting, Coronary Artery Disease JRMS June 2012; 19(2): 76-78 Introduction located in the middle part of the vein graft and dye Coronary Artery Bypass Grafting (CABG) is a swirled in the aneurysmal sac without any flow into widely used surgical therapy for coronary artery the distal coronary circulation (Fig. 1A). The other disease. Great saphenous vein is the traditional grafts were patent with no obvious major pathology conduit used in this procedure. Saphenous Vein Graft identified. A contrast enhanced Computed Aneurysms (SVGA) is rare and usually found Tomogram (CT) scan of the chest measured the incidentally. SGVA should be considered as a aneurysm to be 6.4 x 4.3 cm in cross-section. There possibility in any patient presenting with a was significant mass effect on the right atrium (RA) mediastinal mass after CABG, as early diagnosis and and superior vena cava (SVC) as depicted in (Fig. intervention may avert fatal complications. We report 1B). Additionally, a preoperative Transthoracic a case of a giant SVGA which was successfully Echocardiogram (TTE) showed preserved left treated by surgical excision and coronary ventricular function with severe calcific aortic valve revascularization. stenosis. Surgery was performed through a repeat median sternotomy, with cannulation of the ascending aorta Case Report and right atrium. Antegrade and retrograde A 72-year-old male patient underwent CABG in cardioplegia were used to achieve cardiac standstill 1994 and a subsequent redo CABG in 2000. He and patient was cooled to 32oC. The aortic valve was presented with fatigue and dyspnea in the fall of excised and replaced with a bioprosthesis. The 2010. A cardiac stress test showed inferior and SVGA was identified and the normal vein graft inferoseptal ischemia. Coronary angiogram showed a proximal and distal to it was isolated. Care was taken giant saphenous vein graft aneurysm in the to minimize manipulation so as to decrease the Saphenous Vein Graft (SVG) to the distal right chances of distal embolization. (Fig. 2A) shows the coronary artery. The neck of the aneurysm was SVGA opened longitudinally. From the Departments of Cardiovascular Surgery: * Queen Alia Heart Institute, King Hussein Medical Center, (KHMC), Amman-Jordan ** Mayo Clinic, 100 2nd St. SW, Rochester 55905 USA Correspondence should be addressed to Dr. L. D. Joyce, Division of Cardiovascular Surgery, Mayo Clinic 100 2nd St. SW, Rochester 55905 USA, E-mail: [email protected], or Dr. SE. Altarabsheh: [email protected] 76 JOURNAL OF THE ROYAL MEDICAL SERVICES Vol. 19 No. 2 June 2012 AO SVC SVGA LV RA A B Fig. 1A: Coronary angiography shows the right coronary artery bypass graft marked by the white arrow, and the giant saphenous vein graft aneurysm marked by the smaller white arrows. Fig. 1B: A computed tomographic angiography with contrast reconstructed in an oblique coronal maximum intensity projection demonstrating (AO) the aorta, (SVC) superior vena cava, (SVGA) saphenous vein graft aneurysm, (RA) right atrium and (LV) left ventricle. SVGA SVGA A B Fig. 2: The intraoperative photographs showing the (SVGA) which has been incised longitudinally, with the proximal part of the saphenous vein graft marked by the white arrow, while the distal part is marked by the blue arrow. The proximal orifice (white arrow) and the distal clinical presentations of these aneurysms are normal part of the vein graft (blue arrow) are seen. variable. As in our patient, angina is the most On opening the sac, a large amount laminated common presenting symptom in these patients.(3) thrombus was present lining the wall as shown in Accumulation of clots and debris in the sac may (Fig IIB). All debri and clots were removed without compromise distal flow into the native coronary allowing any particles to migrate into the distal circulation. Additionally distal embolization from coronary circulation. Most of the wall of the intraluminal thrombi may cause acute events aneurysm was excised and the distal part of the depending upon the degree of ischemia. Progression coronary artery was identified, and revasularized of native coronary artery disease can also be one of using a new saphenous vein conduit, which was the causative factors. Rarer patient presentations anastomosed proximally to the ascending aorta. include recurrent shortness of breath, infection, Patient was weaned from the cardiopulmonary hemoptysis, hemothorax, hemopericardium, and bypass uneventfully, and was dismissed from the sudden cardiac death.(4,5) hospital on the sixth postoperative day. SVG aneurysms represent a diagnostic challenge. It is highly crucial to diagnose these aneurysms early in Discussion their course, since they have the potential to Mild dilations of the saphenous vein grafts are embolize, rupture, compress and form fistulae with common, with a reported incidence of up to 14% at other cardiac or vascular structures.(4) Trans Thoracic 5-7 years after coronary artery revascularization Echocardiogram (TTE) may be of importance in surgery utilizing vein conduits.(1) They may be routine detection of mediastinal masses in patients underreported since many of the patients are being with cardiac symptoms. Trans Esophageal asymptomatic. Giant SVG aneurysm is rare and Echocardiography (TEE) is valuable in delineating defined as being greater than 4 cm in diameter.(2) The the size and intraluminal pathological process. Chest JOURNAL OF THE ROYAL MEDICAL SERVICES 77 Vol. 19 No. 2 June 2012 CT scan and Magnetic Resonance Imaging (MRI) are Conclusion considered to be highly useful diagnostic modalities SVG aneurysms after coronary artery by pass for such aneurysms, they usually show a mass with grafting; pose a diagnostic and management central enhancement and eccentrically distributed challenge to the cardiac surgeon, an early diagnosis thrombi. Coronary angiography is very important in with a timely planned management considered to be assessing graft patency and defining coronary the corner stone in approaching such aneurysms. anatomy. SVG aneurysms are usually fusiform in shape and hypothetically form at these weak, thin References walled areas in the vein grafts; however it is highly 1. Kim D, Guthaner D, Wexler L. Transcatheter likely that it may be superimposed by the formation embolization of a leaking pseudoaneurysm of of an atheromatous plaque in the setting of the saphenous vein aortocoronary bypass graft. Cathet degenerative process, which creates a tunica media Cardiovasc Diagn 1983; 9: 591–594. suitable for aneurysmal formation. Venous 2. Scott DH. Aneurysms of the coronary arteries. Am varicosities and surgical trauma during the harvest Heart J 1948; 36:403–421. process and the shear stresses encountered by the 3. Basar S, Schaff HV, Ibrahim U, et al. Surgical arterialization of the venous grafts may be attributed Treatment of Saphenous Vein Graft Aneurysms (6) after Coronary Artery Revascularization. Ann to the added risk of aneurysmal formation. Thorac Surg 2009; 88:1801–5. The exact incidence of rupture in these aneurysms 4. Mylonas I, Sakata Y, Salinger MH, et al. has not been reported but is related to the size of the (7) Successful Closure of a Giant True Saphenous Vein aneurysm. So early surgery is essential to prevent Graft Aneurysm Using the Amplatzer Vascular fatal complications. Conventional treatment of SVG Plug. Catheterization and Cardiovascular aneurysms is still operative excision of such Interventions 2006; 67:611–616. aneurysms with simultaneous revascularization.(3) 5. Ludger W, Birgitta S, Sarah R, et al. Thrombosis The increased risk of sternal reentry after of a large saphenous vein graft aneurysm leading to sternotomy and the possibility of fatal hemorrhage acute myocardial infarction 21 years after coronary from these aneurysms during re-entry are major artery bypass grafting: role of cardiac multi-slice deterrent for surgical therapy. As the cardiac surgical computed tomography. Interact Cardiovasc Thorac Surg. 2011 Feb; 12(2):284-6. Epub 2010 Nov 4. patient has become more elderly with multiple 6. James B, Augustine T, Anoop C. Complete comorbidities, interest has been shifted towards excision of giant calcified saphenous vein graft lesser invasive modes of therapy. Alternative aneurysm in redoes coronary artery bypasses approaches, include coil embolization, thrombin grafting. Interactive CardioVascular and Thoracic injection and percutaneous interventions using stent Surgery 13 (2011) 214-216. grafts or vascular occluder devices.(6) Given the 7. Wester DJ, Martinez HO, Camp A. Aneurysm of variability in the anatomy of these aneurysms and the a saphenous vein graft manifested as a mediastinal status of the coronary artery distal to the aneurysm, mass on chest radiographs. American Journal of the type of percutaneous intervention is usually Roentgenology. 1993; 161(5):951–952. selected on case by case basis. Endovascular covered 8. Tamirisa PK, Rinder M, Singh J, et al. Thrombin injection to treat pseudoaneurysm of internal stents are useful when there is continuous antegrade mammary artery bypass graft: a case report. flow in the SVG graft is the aim, however when the Catheterization and Cardiovascular Interventions. distal SVG graft is occluded, Coil embolization or 2002; 57(4):548–551. (8) thrombin injection may be used. 78 JOURNAL OF THE ROYAL MEDICAL SERVICES Vol. 19 No. 2 June 2012 .
Load more

Recommended publications
  • ICD-10 and Cardiology Steven M
    ICD-10-CM and Cardiology Steven M. Verno, CMBSI, CEMCS, CMSCS, CPM-MCS Page 1 of 24 ICD-10 and Cardiology Steven M. Verno, CMBSI, CEMCS, CMSCS, CPM-MCS Note: ICD-9-CM and ICD-10 are owned and copyrighted by the World Health Organization. The codes in this guide were obtained from the US Department of Health and Human Services, NCHS website. This guide does not contain ANY legal advice. This guide shows what specific codes will change to when ICD-9-CM becomes ICD-10-CM. This guide does NOT discuss ICD-10-PCS. This guide does NOT replace ICD-10-CM coding manuals. This guide simply shows a practice what ICD-10-CM will look like within their specialty. The intent is to show that ICD-10 is not scary and it is not complicated. This guide is NOT the final answer to coding issues experienced in a medical practice. This guide does NOT replace proper coding training required by a medical coder and a medical practice. Images or graphics were obtained from free public domain internet websites and may hold copyright privileges by the owner. This guide was prepared for Free. If you paid for this, demand the return of your money! If the name of the original author, Steve Verno, has been replaced, it is possible that you have a thief on your hands. Page 2 of 24 For the past thirty-one (31) years, we have learned and used ICD-9-CM when diagnosis coding for our providers. ICD stands for International Classification of Diseases.
    [Show full text]
  • Perioperative Stress Testing: the New High Risk Paradigm
    medigraphic Artemisaen línea E A NO D NEST A ES Mexicana de IC IO EX L M O G O I ÍA G A E L . C C O . C Revista A N A T Í E Anestesiología S G S O O L C IO I S ED TE A ES D M AN EXICANA DE PROFESORES EXTRANJEROS Vol. 32. Supl. 1, Abril-Junio 2009 pp S198-S206 Perioperative stress testing: The new high risk paradigm Marc A. Rozner, PhD, MD* * Professor of Anesthesiology and Perioperative Medicine. Professor of Cardiology The University of Texas MD Anderson Cancer Center. Houston, TX [email protected] INTRODUCTION Each scenarios (i.e.; should have been tested but was not; did not need the test but was tested anyway, got tested For sometime, anesthesiologists have been asked to assist and intervention) is accompanied by financial and medi- in the assignment of risk for an operative procedure, espe- cal complication issues that are beyond the scope of this cially the patient with cardiac disease. For most of these talk. It is important to keep in mind that every medical test patients, the preoperative assessment involves a decision and procedure has a potential downside – a significant about getting a stress test and dealing with the results. But aspect to the patient with a positive stress test who has a there is little data to support this practice, and recent events stroke during the follow-up, clean cardiac catheterization. suggesting that mechanical coronary artery intervention In their Guideline Update for exercise testing, the ACC / actually increases perioperative risk of MI and death have AHA quote a rate for myocardial infarction and / or death muddied the perioperative water.
    [Show full text]
  • Download PDF File
    Cardiology Journal 2008, Vol. 15, No. 1, pp. 4–16 Copyright © 2008 Via Medica REVIEW ARTICLE ISSN 1897–5593 Early repolarization variant: Epidemiological aspects, mechanism, and differential diagnosis Andrés Ricardo Pérez Riera1, Augusto Hiroshi Uchida2, Edgardo Schapachnik3, Sérgio Dubner4, Li Zhang5, Celso Ferreira Filho6 and Celso Ferreira7 1Electro-Vectorcardigraphic Section, ABC Medical School, ABC Foundation, Santo André, São Paulo, Brazil 2Electrocardiology Service, Heart Institute (InCor) of the University of São Paulo Medical School, São Paulo, Brazil 3Department of Chagas Disease, Dr. Cosme Argerich Hospital, Buenos Aires, Argentina 4Arrhythmias and Electrophysiology Service, Clinical y Maternidad Suizo Argentina, Buenos Aires, Argentina 5LDS Hospital and University of Utah School of Medicine, SALT Lake City UT, USA 6Cardiology Division, ABC School of Medicine, ABC Foundation and School of Medicine of Santo Amaro, UNISA, São Paulo, Brazil 7Cardiology Division, ABC School of Medicine, ABC Foundation, Santo André, São Paulo, Brazil Abstract Early repolarization variant (ERV or ERPV) is a enigmatic electrocardiographic phenom- enon, characterized by prominent J wave and ST-segment elevation in multiple leads. Recently, there has been renewed interest in ERV because of similarities to the arrhythmogenic Brugada syndrome (BrS). Not much is known about the epidemiology of ERV and several studies have reported that this condition is associated with a good prognosis. Both syndromes exhibit some similarities including the ionic underlying mechanism, the analogous responses to changes in heart rate and autonomic tone, sympathicomimetics (isoproterenol test) as well as in sodium channel and beta-blockers. These observations raise the hypothesis that ERV may be not as benign as traditionally believed. Additionally, there are documents showing that ST-segment height in the man is greatly influenced by central sympathetic nervous activity, both at baseline and during physiologic and pharmacological stress.
    [Show full text]
  • Chapter Xi Medicine Evaluation and Management Services Cpt Codes 90000 - 99999 for National Correct Coding Initiative Policy Manual for Medicare Services
    CHAP11-CPTcodes90000-99999 Revision Date: 1/1/2021 CHAPTER XI MEDICINE EVALUATION AND MANAGEMENT SERVICES CPT CODES 90000 - 99999 FOR NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL FOR MEDICARE SERVICES Current Procedural Terminology (CPT) codes, descriptions and other data only are copyright 2020 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. Applicable FARS\DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors, prospective payment systems, and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein. Table of Contents Chapter XI ................................................. XI-3 Medicine Evaluation and Management Services CPT Codes 90000 - 99999 ..................................................... XI-3 A. Introduction .........................................XI-3 B. Therapeutic or Diagnostic Infusions/Injections and ...XI-3 Immunizations ............................................XI-3 C. Psychiatric Services .................................XI-8 D. Biofeedback .........................................XI-10 E. Dialysis ............................................XI-10 F. Gastroenterology ....................................XI-11 G. Ophthalmology .......................................XI-12 H.
    [Show full text]
  • Icd-9-Cm (2010)
    ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular
    [Show full text]
  • Exercise / Pharmacologic / Stress Echo)
    CARDIAC STRESS TEST (EXERCISE / PHARMACOLOGIC / STRESS ECHO) A diagnostic procedure used to measure the heart’s ability to respond to external stress in a controlled clinical environment. At Chinatown Cardiology, P.C., heart stimulation is either provided by exercising on a treadmill or injection of intravenous vasodilators such as adenosine or dobutamine. The latter is usually used when you have medical problems that prevent you from being able to complete the necessary exercise; this is called a pharmacologic stress test. Stress tests are useful in comparing the coronary circulation of a patient while at rest with the patient’s circulation during maximum exercise capacity. Findings will show any abnormal blood flow to the heart’s muscle tissue and provide information about the patient’s physical condition or symptoms. Oftentimes, stress tests can help diagnose coronary heart disease (CHD), a condition in which plaque builds up in the coronary artery. These arteries supply oxygen­rich blood to your heart. Plaque buildup causes narrowed arteries (incomplete perfusion) and blood clot formation (arterial blockage). Blocked arteries may cause chest pain or angina. Stress echocardiography or exercise echocardiogram: This non­invasive test consists of a stress test accompanied by an echocardiogram. The echocardiogram is performed both before (baseline) and after (peak heart rate) the exercise. Structural differences and wall motion are compared. Ischemia of one or more coronary arteries could cause wall motion abnormalities, indicating coronary artery disease. Nuclear stress test: Commonly known as “myocardial perfusion imaging.” This procedure utilizes the distribution of an intravenous dose of radiotracer (Tc­99m Sestamibi or Thallous Chlordie 201) to capture images of the blood flow using a special camera.
    [Show full text]
  • A Long-Term Outcomes Study to Assess Statin Residual Risk Reduction with Epanova in High Cardiovascular Risk Patients with Hypertriglyceridemia (STRENGTH)
    Statistical Analysis Plan Study Code D5881C00004 Edition Number Version 5.0 Date 22 April 2020 A Long-Term Outcomes Study to Assess STatin Residual Risk Reduction with EpaNova in HiGh Cardiovascular Risk PatienTs with Hypertriglyceridemia (STRENGTH) 1 Statistical Analysis Plan Study Code D5881C00004 Edition Number Version 5.0 Date 22 April 2020 A Long-Term Outcomes Study to Assess STatin Residual Risk Reduction with EpaNova in HiGh Cardiovascular Risk PatienTs with Hypertriglyceridemia (STRENGTH) Study Statistician Redacted Date Redacte Redact , IQVIA Redacted 20124 Milano Italy 2 Statistical Analysis Plan Study Code D5881C00004 Edition Number Version 5.0 Date 22 April 2020 A Long-Term Outcomes Study to Assess STatin Residual Risk Reduction with EpaNova in HiGh Cardiovascular Risk PatienTs with Hypertriglyceridemia (STRENGTH) Global Product Statistician Redacted Date Senior Statistician Biometrics, Late-stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D AstraZeneca 3 Redacted Statistical Analysis Plan Study Code D5881C00004 Edition Number Version 5.0 Date 22 April 2020 TABLE OF CONTENTS PAGE TITLE PAGE ............................................................................................................................ 1 SIGNATURE OF STUDY STATISTICIAN ........................................................................... 2 SIGNATURE OF GLOBAL PRODUCT STATISTICIAN .................................................... 3 TABLE OF CONTENTS ........................................................................................................
    [Show full text]
  • Stress Test Brochure
    Preparing for a Stress Electrocardiogram Care Management Services When You Come to Take the Test Please check in at the Outpatient Registration desk at Greene County Medical Center in Jefferson on: Day: _______________________ Date: _______________________ Time: _______________________ Do you have other questions? You may direct any other questions or Hours: concerns you may have regarding your Monday - Friday upcoming cardiac stress test to the staff: 8 a.m. - 4:30 p.m. Cardiac Management 515-386-0469 (515) 386-0469 FAX: (515) 386-2017 Greene County Medical Center 1000 West Lincolnway Jefferson, IA 50129 gcmchealth.com PS-GCMC-016 11-2014 What is a stress What happens during the test? Preparing for the Test electrocardiogram (ECG)? The exercise ECG test will be performed in If you take a beta blocker or any other An exercise ECG test allows doctors to the Cardiac Management department of the medication listed here, DO NOT take them the learn how well the heart functions when medical center. A trained technician will place night before or the morning of the test. It is a it is made to work harder. This test can several electrodes on your chest to allow good idea to check with your doctor first if you help detect heart problems that may recording of the ECG during exercise. The are on a heart medication not listed here. He not be apparent at rest. The exercise electrodes are connected by wires to an ECG or she may want you to hold that medication ECG test is done while you walk on machine.
    [Show full text]
  • Coronary Disease in Emergency Department Chest Pain Patients with Recent Negative Stress Testing
    Original research Coronary Disease in Emergency Department Chest Pain Patients with Recent Negative Stress Testing Jonathan Walker, DO York Hospital, Department of Emergency Medicine, York, PA Michael Galuska, MD David Vega, MD Supervising Section Editor: Shahram Lotfipour, MD, MPH Submission history: Submitted July 10, 2009; Revision Received February 12, 2010; Accepted April 7, 2010 Reprints available through open access at http://escholarship.org/uc/uciem_westjem Background: Cardiac stress tests for diagnosis of coronary artery disease (CAD) are incompletely sensitive and specific. Objective: We examined the frequency of significant CAD in patients presenting to the emergency department (ED) with chest pain who have had a recent negative or inconclusive (<85% of predicted maximum heart rate) cardiac stress test. Methods: This was a retrospective chart review of patients identified from ED and cardiology registries at the study hospital. We included patients presenting to the ED with a chief complaint of chest pain, with a negative cardiac stress test in the past three years as the last cardiac test, and hospital admission. One-hundred sixty-four patients met the inclusion criteria. Their admission was reviewed for diagnosis of CAD by positive serum troponin, percutaneous coronary intervention, or positive stress test while an inpatient. Results: Of 164 patients, 122 (74.4%, 95% CI 67.7, 81.1) had a negative stress test prior to the index admission, while 42 (25.6%, 95% CI 18.9, 32.3) had otherwise normal but inconclusive stress tests. Thirty-four (20.7%, 95% CI 14.4,27.0) of the included patients were determined to have CAD. Twenty-five of the 122 patients (20.5%, 95% CI 13.3, 27.7) had negative pre-admission stress tests and nine of 42 patients (21.4%, 95% CI 9.0, 33.8) had inclusive stress tests of CAD.
    [Show full text]
  • Cardiac Stress Test 8
    Cardiac Stress Test 8. You will then return to the camera room to have a second 20 minute picture performed. You will be For the success of the scan and for your safety, tell Date: ______________________________________ You have been scheduled for a Cardiac Stress Test, positioned under the same Gamma Camera and a the nurse or technologist if you which involves the use of a small amount of second set of pictures of your heart will be taken. Are pregnant or breastfeeding (or if there is radioactive material. The level of radioactivity used 9. This entire procedure takes between 4 and 5 hours. any chance of pregnancy). Time: is extremely low and has no side effects. In some cases a separate set of images 24 hours Have had a Cardiac Stress Test before (or ______________________________________ later may be necessary. other tests pertaining to your symptoms). You will be positioned next to a special detector 10. Your referring physician will receive a written Have had a Cardiac Catheterization, called a Gamma Camera. The camera does not report from the Cardiac Stress Test 48 hours after Angioplasty or Bypass Surgery. produce any radiation. It will be placed close to your your test is complete. Are taking any medications. heart. Have had a recent Barium Study or x-rays Patient Preparation: using contrast. Patient Information: Are unable to hold your left arm above you Place: Please follow the following preparation prior to your head. Goshen Hospital 1. Please report to Goshen Hospital 15 minutes prior Cardiac Stress Test: 200 High Park Ave. to your scheduled test time.
    [Show full text]
  • IHE Cardiology Technical Framework Supplement Stress Testing Workflow
    Integrating the Healthcare Enterprise 5 IHE Cardiology Technical Framework Supplement 10 Stress Testing Workflow (STRESS) 15 Trial Implementation 20 Date: August 29, 2013 Author: IHE Cardiology Technical Committee Email: [email protected] 25 Copyright © 2013: IHE International, Inc. IHE Cardiology Technical Framework Supplement – Stress Testing Workflow (STRESS) ______________________________________________________________________________ Foreword This is a supplement to the IHE Cardiology Technical Framework 5.0. Each supplement undergoes a process of public comment and trial implementation before being incorporated into the volumes of the Technical Frameworks. 30 This supplement is submitted for trial implementation as of August 29, 2013 and may be available for testing at subsequent IHE Connectathons. The supplement may be amended based on the results of testing. Following successful testing it will be incorporated into the Cardiology Technical Framework. Comments are invited and may be submitted at http://www.ihe.net/Cardiology_Public_Comments. 35 This supplement describes changes to the existing technical framework documents and where indicated amends text by addition (bold underline) or removal (bold strikethrough), as well as addition of large new sections introduced by editor’s instructions to “add new text” or similar, which for readability are not bolded or underlined. “Boxed” instructions like the sample below indicate to the Volume Editor how to integrate the 40 relevant section(s) into the relevant Technical Framework volume: Replace section X.X by the following: General information about IHE can be found at: www.ihe.net. 45 Information about the IHE Cardiology domain can be found at: http://www.ihe.net/IHE_Domains. Information about the organization of IHE Technical Frameworks and Supplements and the process used to create them can be found at: http://www.ihe.net/IHE_Process and http://www.ihe.net/Profiles.
    [Show full text]
  • Basic Coding Guidance for Billing MPI SPECT Part 1
    June 2010 What ASNC MEMBERS NEED TO KNOW ABOUT Coding Basic Coding Guidance for Billing MPI SPECT PART 1 performed); multiple studies, at rest primarily to identify medical services and Myocardial perfusion imaging (MPI), and/or stress (exercise or pharmaco- procedures furnished and billed by physi- through utilization of a gamma camera logic) and/or redistribution and/or rest cians and other health care professionals. employing Single-Photon Emission Com- reinjection puted Tomography (SPECT) technology, Because Medicare and other insurers has been viewed over the past decade as 93015-93018: Cardiovascular stress cover a variety of services, supplies, and the gold standard for determining critical testing. Choose appropriate code(s) equipment that are not identified by coronary artery stenosis. In addition, MPI from the stress test series. CPT codes, HCPCS Level II codes were represents roughly 95 percent of all car- established for submitting claims for *** Note: Also bill any appropriate HCPCS diovascular procedures performed using these items during the 1980s. HCPCS code for the use of radiopharmaceuticals or nuclear imaging and has been identified by drugs administered during the MPI study or Level II codes are also referred to as Medicare as a high-volume procedure. stress test.*** alphanumeric codes because they consist of a single alphabetical letter followed by For these reasons, ASNC has compiled Q: How do MPI Planar studies differ four numeric digits, while CPT codes are some common questions about the typical from MPI SPECT studies? identified using five numeric digits. coding package that usually accompa- A: While SPECT technology allows the nies HCPCS Level I Current Procedural Q: When looking at the alphanu- nuclear cardiologist to view a three- Terminology (CPT) codes 78451 and 78452 meric HCPCS Level II codes, dimensional image of a specific area, for MPI SPECT single and multiple studies, which parts of “the alphabet” are planar imaging only produces a respectively.
    [Show full text]