Medical Transcription Cardiovascular Operative Sample Reports for Medical Transcriptionists:
OPERATIONS PERFORMED: Intraoperative transesophageal echocardiogram with interpretation; coronary vascularization x3 using left internal mammary artery to the severely diffuse diseased anterior descending artery, saphenous vein graft from the aorta to the middle obtuse marginal artery and the right coronary artery; aortic valve replacement.
OPERATION IN DETAIL: The patient was brought in to the operating room and placed in the supine position. After general endotracheal anesthesia, the patient was prepped and draped in the usual fashion. Median sternotomy was utilized. Simultaneously, the saphenous vein grafts were harvested from the lower extremities. The left internal mammary artery was taken down with cauterization and clips. The patient was heparinized and cannulated in the usual fashion. The patient was placed on cardiopulmonary bypass and the aorta was cross-clamped. Antegrade as well as retrograde cardioplegic arrest was obtained and was also cooled systemically. Attention was directed to the right coronary system. There was a 2.6 mm vessel with some diffuse disease present with posterior plaquing. It was anastomosed, saphenous vein graft, with good flow following anastomosis. The obtuse marginal was a 2 mm vessel. It was also anastomosed with a saphenous vein graft with good flow. At that point, the anterior descending artery was opened. There was severely diffuse disease. It was anastomosed to the left internal mammary artery with a running 8-0 Prolene suture. At that point, the aorta was opened in tangential fashion. The valve was severely calcified and cut out. Using pituitary rongeuer, we decalcified the annulus. We sewed a 23 mm pericardial valve into place. We used a ThermaFix supraannular valve. The aorta was closed in two layers with running 4-0 Prolene suture. Once this was completed, proximal anastomosis was performed of the ascending aorta. This was done with running 5-0 Prolene suture. Clamp was removed. The aorta was de-aired. Satisfactory flow was obtained. The patient was allowed to reperfuse for a brief period of time and was weaned off cardiopulmonary bypass uneventfully. Two ventricular and one right atrial pacing wires were placed. One mediastinal and one left pleural chest tube was placed. The chest was closed in routine fashion and postoperative record revealed good bioprosthetic valve function. The mitral insufficiency was somewhat improved with just mild to moderate insufficiency with just a mild central jet. The rest of the examination was unremarkable. The patient was transported to cardiovascular recovery unit postoperatively in stable condition.
OPERATION PERFORMED: Dual chamber pacemaker placement with lead fluoroscopy and right upper extremity venogram and hand injection and synchronous direct-current cardioversion.
OPERATION IN DETAIL: After informed consent, the patient was brought to the operating room in a fasting unsedated state. Continuous electrocardiograph monitoring, noninvasive blood pressure monitoring, pulse oximetry and standby pacing and defibrillator pads were provided. In addition, the patient was evaluated by the anesthesiologist who provided for sedation and airway management. The right prepectoral area was prepped and draped in a sterile manner and anesthetized with 2% Xylocaine. A 2 cm incision was made two fingerbreadths inferior to the clavicle near the deltopectoral groove. Using blunt dissection and electrocautery, a pocket was made for the pacemaker at the level of the pectoralis fascia. Using a blunt dissection in deltopectoral groove, the left cephalic vein was located and dissected free. The distal portion of the vein was tied with 0 Ethibond tie and the proximal portion was looped with an 0 Ethibond loop. The vein was incised and an attempt was made to insert a vein pick and cannulate the vein. However, this cephalic vein was not of sufficient quality structurally and the cephalic approach was therefore stopped. The proximal tie was tied. Next, with the patient in Trendelenburg position, a right upper extremity venogram was performed using 10 mL of nonionic low-molecular weight contrast to visualize the course of the right subclavian vein. Using this venogram as well as anatomic and fluoroscopic landmarks of the guide, the extrathoracic portion of the right subclavian vein near the transition to the axillary vein was cannulated via modified Seldinger technique and 0.035 guidewires were placed x2 and advanced under fluoroscopic guidance to the cavoatrial junction. The patient was taken out of Trendelenburg position, and first, the guidewire was used to place a #7-French peelable introducer, which was used in turn to advance the ventricular lead under fluoroscopic guidance to the septal portion of the right ventricular apex. The active fixation screw was advanced and parameters were measured as below. High output pacing did not stimulate the diaphragm. The ventricular lead was sutured in place using the suture sleeve and 0 Ethibond sutures x2 into the pectoralis fascia. Next, the remaining guidewire was used to place a second 7-French peelable introducer, which was used in turn to advance the atrial lead under fluoroscopic guidance. The atrial lead was placed in the high right atrium area and the active fixation screw was advanced. Stable position and impedance in atrial fibrillation and good atrial fibrillation electrogram were obtained. Next, using 100 joule biphasic waveform, anteroposterior atrial fibrillation was terminated and sinus rhythm ensued with temporary pacing provided by the pacing system's analyzer connected to the atrial lead and the ventricular lead. The patient remained out of atrial fibrillation and did not convert back into atrial fibrillation during the procedure. The atrial lead was sutured in place using a suture sleeve and 0 Ethibond sutures x2 into the pectoralis fascia. Careful attention was paid to hemostasis in the pocket. The pocket was then irrigated with antibiotic solution. The pacemaker leads were attached to the pacemaker generator and proper operation was confirmed. The leads and generator were placed in the pocket. A fluoroscopic survey was made of the pocket as well as the leads, and there was also no evidence of right-sided pneumothorax on fluoroscopy. The sponge and needle counts were correct. Deep portion of the pocket was lined with FloSeal thrombin paste. The pocket was closed with two layers of 3-0 Vicryl running suture as well as subcuticular layer of 4-0 Vicryl running suture and Dermabond adhesive on the skin surface. The patient tolerated the procedure well and was discharged from the operating room in good condition without any immediate postprocedure complications. A chest x-ray was ordered to exclude pneumothorax.