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Memorial Outpatient Clinic
Pediatric Echocardiography Report
Patient Name:
Study Date:
Height:
Weight:
BSA:
Indications:
History/Clinical:
Procedure:
Quality:
Previous Study:
Braun, Mark
4/17/2016
Gender: M
91.4 cm
97/68
BP:
40.4 kg
82
HR:
0.91 m²
Abnormal Physical Exam, Pulmonic insufficiency
Cyanotic Spells, Respiratory Problem, Acute
2D, M-mode, Doppler, Color Flow
Adequate
Date: 03/31/2016 on Tape # 012588
MRN#:
Ordering MD:
Interpreting MD:
Technologist:
DOB, Age:
84187
Jill Dunham, MD
Albert Cheng, MD
Sandra Black, RDCS
11/18/2011, 4 yr
Summary
Situs and Cardiac Position: There is levocardia with visceral and atrial situs solitus, concordant atrioventricular and
ventriculoarterial connections and normally related great arteries.
Venous Connections: Normal systemic venous connections. Normal pulmonary venous connections. At least two pulmonary
veins are demonstrated draining to the left atrium with laminar flow by color Doppler.
Atria: The left atrium (LA) is mildly dilated. The right atrium (RA) is normal in size.
Atrial Septum: Intact atrial septum with no evidence of interatrial shunting.
Atrioventricular Junction: Structurally and functionally normal mitral valve with normal spectral and color flow Doppler.
Structurally and functionally normal tricuspid valve with mild regurgitation. Accelerated antegrade tricuspid valve flow by
Doppler.
Ventricles: The left ventricle (LV) is mildly dilated with mild hypertrophy and moderately reduced systolic function. The right
ventricle (RV) is moderately dilated with normal wall thickness and normal systolic function.
Ventricular Septum: Moderate apical muscular ventricular septal defect (VSD) with restrictive bidirectional shunting. Multiple
muscular ventricular septal defects ("Swiss cheese septum") .
Outflow tracts: The left ventricular outflow tract is mildly hypoplastic with unobstructed flow. The right ventricular outflow
tract is normal in size with unobstructed flow.
Semilunar Valves: The aortic valve is structurally and functionally normal. Normal antegrade flow; no regurgitation. The
pulmonary valve (PV) is structurally and functionally normal. Normal antegrade flow; physiologic regurgitation.
Aortic & Pulmonary Root: The aortic root, sinuses of Valsalva, sinotubular junction and proximal ascending aorta are normal.
The pulmonary root is normal, without dilation or stenosis.
Thoracic Arteries: The ascending aorta is mildly dilated. Left aortic arch with normal brachiocephalic artery branching. There
is normal antegrade flow in the aortic arch. There is no coarctation of the aorta. No patent ductus arteriosus is seen. The main and
branch pulmonary arteries are of normal size with normal flow velocities.
Coronary Arteries: The origin and proximal course of the right and left coronary arteries are normal.
Pericardium/Pleural: No pericardial effusion. No pleural effusion seen.
Braun, Mark
Pediatric Echo Report
04/17/2016
84187
Page 1
Braun, Mark
Pediatric Echo Report
04/17/2016
2D Measurements
LV A%
LVIDd
LV Ad
LVEDV
LV As
LVESV
LV SV
16.9 % (40-60) *
43.4 mm (zsc 2)
33.3 cm²
107 ml
27.7 cm²
79.5 ml
98.2 ml (zsc 8.6) *
LV EF
HR
LV CO
LV CI
Ao Rtd
AV ann
55.3 % (zsc -1.6)
88 bpm
2.1 l/min
2.3 l/min/m²
19.4 mm (zsc -0.3)
8.4 mm (zsc -5.2) *
84187
Page 2
Doppler Measurements
MV Forward Flow
MV pkVel 29.8 cm/s
MV pkPG 0.4 mmHg
MV mnVel 16.2 cm/s
MV mnPG
MV VTI
0.1 mmHg
6.5 cm
Images
Stent
Bypass
VSD
Dextrocardia With Situs Inversus (Dextrocardia). Normal Heart With 'Mirror Image'
Dextrocardia; Normal Atrioventricular Connection; Normally Connected Great
Arteries. Right aortic arch.
Physician Signature
Braun, Mark
Pediatric Echo Report
<Electronic Signature>
04/18/2016 01:02 PM
_____________________________________
Albert Cheng, MD
04/17/2016
84187
Page 2
Memorial Medical Center
Cardiac Catheterization Report
Patient Name:
Study Date:
Height:
Weight:
BSA:
Outpatient
ICD:
Diaz, Johnny
6/6/2016
73.66 cm
16.36 kg
0.53 m²
Patient ID:
Priority:
DOB, Age:
CPT:
Gender: M
BP:
138/67
HR:
85
RH00235620
ROUTINE
11/8/2013, 2 yr
93531, 93544, 33881, 75957
4A023N8, 02VW3DZ,
Q25.1
Left and Right Heart Catheterization Congenital, Endovascular TAA repair w/o Subclavian coverage, XRAY
Endovascular Thoracic Aorta Repair, Injection procedure during Cardiac Catheterization, for Aorta
Procedure:
Stage 1
Pressures
(mmHg)
Sys/A
101
102
83
100
15
23
20
19
14
AO
AOAsc
AODsc
LV
RA
RV
MPA
RPA
PCW
Dias/V Mn/EDP
62
75
60
76
55
62
12
19
10
11
8
10
8
13
7
12
5
8
101/62
75
97%
83/55
62
98%
102/60
76
20/8
13
Oximetry
(%, mmHg)
Sat
98
98
97
77
77
79
77
79
79
98
AO
AOAsc
AODsc
SVC
SVCHi
IVC
RA
RV
MPA
RUPV
PaO2
77%
15/10
11
100/12
19
23/8
10
79%
Shunts & Resistances
Eff Flow (Qep)
(Qep) I
Qp
Qp I
L-R Shunt
% L-R
Rp
Rp I
TPR
TPRI
1.42
2.68
1.52
2.87
0.1
6.58
3.29
1.74
8.55
4.53
l/min
l/min/m²
l/min
l/min/m²
l/min
%
(WU)
(WU)
(WU)
(WU)
Cardiac Output
HR
Hgb
VO2
VO2 I
CAo2
CVo2
PAo2
PVo2
O2cap
99
13.2
51.94
98
97.67
77.67
79
98
179.52
Diaz, Johnny
Cath Lab Report
bpm
g/dL
ml/min
ml/min/m²
%
%
%
%
ml O2/l
.
SAC
MVC
PAC
PVC
Fick CO
Fick CI
175.34
139.43
141.82
175.93
1.45
2.74
ml O2/l
ml O2/l
ml O2/l
ml O2/l
l/min
l/min/m²
Arterial Blood Gases
pH
PaO2
PaCO2
HCO3
BE
7.3
93
32
23.1
-0.9
mmHg
mmHg
mEq/l
mEq/l
Valve Areas / Gradients
Peak Mean Areas
(mmHg) (mmHg)
AV
2
1
(cm²)
2.36
06/06/2016
RH00235620
Page 1
Diaz, Johnny
Cath Lab Report
06/06/2016
RH00235620
Page 2
Stage 2
Pressures
(mmHg)
AOAsc
AODsc
Sys/A
101
98
Dias/V Mn/EDP
62
75
61
77
Post Coarctation Repair
98%
Oximetry
(%, mmHg)
Sat
98
98
78
AOAsc
AODsc
SVC
PaO2
101/62
75
Stent
98/61
77
98%
Cardiac Output
VO2
VO2 I
CAo2
CVo2
51.94
98
98
78
ml/min
ml/min/m²
%
%
Situs Solitus, Levocardia. Normal (atrioventricular concordance, normally connected great
arteries). Aortic arch anomalies. Coarctation of aorta (COA).
Diaz, Johnny
RH00235620
11/8/2013 2 yr
6/6/2016
HISTORY: Diaz, Johnny is a 2 yr old M with discrete coarctation of the aorta and left ventricular hypertrophy presenting for
diagnostic study and intervention.
PROCEDURE: Informed consent was obtained prior to the procedure after discussing the pros and cons of all reasonable
alternatives. The patient was brought to the cardiac catheterization laboratory and placed under general anesthesia by the cardiac
anesthesia service. The airway was managed with an ETT. A pre-procedural “time out” was performed. The bilateral groins were
prepped and draped in the usual sterile fashion. Access was not difficult using Sonosite. Using a modified Seldinger technique, a
5F short sheath was placed in the right femoral vein and a 4F short sheath was placed in the right femoral artery. After obtaining
access, the patient was heparinized to maintain ACTs greater than 220 seconds.
At the beginning of the case we performed antegrade right heart catheterization using a 5F end-hole wedge catheter and a
retrograde left heart catheterization using a 4F multi-marker pigtail catheter. After obtaining baseline oximetry and
hemodynamics, we performed aortic angiography in biplane projections.
After imaging the coarctation, we positioned a 0.035 Amplatzer SuperStiff wire in the right subclavian artery retrograde from the
aorta. The arterial sheath was upsized to a 9F flex sheath and advanced across the coarctation into the distal aortic arch. A 36mm
Max LD stent was hand-mounted onto a 16-4 Balloon-in-balloon (BIB) catheter. The stent was advanced to the end of the long
Diaz, Johnny
Cath Lab Report
06/06/2016
RH00235620
Page 2
Diaz, Johnny
Cath Lab Report
06/06/2016
RH00235620
Page 3
arterial sheath and positioned at the level of the coarctation. The stent was uncovered without difficulty and the position was
confirmed with small hand injections through the long sheath. The inner balloon was inflated to [5 atm] and position was again
confirmed by small hand injection. The outer balloon was inflated to 6 atm and the stent was fully deployed across the coarctation.
Due to residual narrowing at the mid-portion of the stent, we performed post-dilation using a 18-2 Atlas Gold. A cut pigtail
catheter was then advanced across the coarctation and pressures were measured above and below the stent simultaneously. The
wire was removed and a final angiogram was performed through the cut pigtail.
At the end of the case, ropivacaine was infused for additional analgesia. Sheaths were pulled and hemostasis was obtained by
manual pressure. There was no hematoma and no pulse loss. The patient was extubated in the cath lab and transferred to the cath
recovery unit in stable condition.
Complications: none.
Total fluoroscopy time: 10 min
Total contrast used: 20 mL
Estimated Blood Loss: 20 mL
Angiography
a. A 3D rotational angiography was performed with a power injection in the ascending aorta with RV pacing. Angiography
showed a mildly dilated ascending aorta with a normal transverse aorta. There is a Left aortic arch with normal branching
pattern of the head and neck vessels. There is severe discrete coarctation of the distal arch with normal caliber descending
aorta. There are multiple collaterals seen on this injection
b. In straight AP and lateral projections, a multi-marker pigtail catheter has been advanced retrograde across the coarctation
into the distal aortic arch. Power injection into the distal aortic arch demonstrate mildly dilated ascending aorta with a normal
transverse aorta. There is a Left aortic arch with normal branching pattern of the head and neck vessels. There is severe
discrete coarctation of the distal arch with normal caliber descending aorta. There are multiple collaterals seen on this
injection.
IMPRESSION: Diaz, Johnny is a 2 yr old M with discrete coarctation of the aorta and left ventricular hypertrophy presenting for
diagnostic study and intervention.
1) Normal baseline cardiac index.
2) Severe juxtaductal coarctation with peak-to-peak gradient of 30 mmHg gradient.
3) Coarctation stented primarily with 36 mm Max LD and post-dilated using 18 mm Atlas Gold with significant angiographic
improvement and reduction in peak-to-peak gradient to < 10mmHg.
4) No complications.
Interpreting MD 1 was present throughout the entire case.
cc: primary cardiologist and primary care
<Electronic Signature>
01/11/2017 12:01 PM
_____________________________________
Interpreting MD 1
Revised
Cath Pre-Procedure
Labs
Hgb
13.2 g/dL
Hct
35 %
INR
1.2
Potassium 4.1 mEq/L
Diaz, Johnny
Cath Lab Report
Sodium
Creatinine
BUN
152 mEq/L
1 mg/dL
16 mg/dL
Pulses
Bilateral DP: 3+
Bilateral PT: 3+
06/06/2016
RH00235620
Page 3