DESCRIPTION OF PROCEDURE: Informed consent was obtained from the patient prior to the procedure. The patient was prepped and draped in the usual sterile fashion. The right groin was anesthetized with 2% lidocaine. A 6 French sheath was introduced in the right femoral artery via modified Seldinger technique. A 6 French angled pigtail was used for left ventriculography and aortic valve pullback, and 6 French JL4 and JR4 catheters were used for selective coronary angiography. Multiple views were obtained.
FINDINGS: The coronary circulation was right dominant.
Left main artery: The vessel was long and large in caliber with minimal 10-20% narrowing.
Left anterior descending artery: The vessel was long and coursed in the interventricular groove towards the apex. The proximal vessel had a previously placed stent with 40-50% diffuse in-stent re-stenosis, which did not appear to be flow-limiting and was unchanged from the prior angiogram. Beyond the stent was an area of tortuosity followed by the mid vessel, which had a previous stent which was widely patent. Beyond the stent, in the later portion of the mid vessel, was an area of ectasia which was unchanged from the prior angiogram. The second diagonal branch arose from this area and had a 40-50% narrowing in its mid portion, which was unchanged from the prior angiogram. The distal portion of the left anterior descending in its course toward the apex had mild diffuse nonobstructive disease.
Left circumflex artery: The vessel had a previously placed stent in the mid vessel, which was widely patent. The second obtuse marginal branch was a medium to large caliber vessel which had 30% narrowing at its ostium and a focal 40-50% narrowing in the mid to distal portion, which was unchanged from the prior angiogram.
The third obtuse marginal branch had 30% diffuse narrowing.
Right coronary artery: The previously placed stent in the proximal and middle vessel had 20-30% diffuse mild in-stent re-stenosis. The distal vessel had 40-50% diffuse disease with a previously placed stent in the distal vessel widely patent. This was unchanged from the prior angiogram. An acute marginal branch arose from the mid vessel with an ostial 90% stenosis. This was a small caliber vessel, which was unchanged from the prior angiogram.
Left ventricle: Ejection fraction 65%. There were no wall motion abnormalities, mitral regurgitation, or aortic valve gradient. The left ventricular end diastolic pressure was 12.
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FINDINGS: The coronary circulation was right dominant.
Left main artery: The vessel was long and large in caliber with minimal 10-20% narrowing.
Left anterior descending artery: The vessel was long and coursed in the interventricular groove towards the apex. The proximal vessel had a previously placed stent with 40-50% diffuse in-stent re-stenosis, which did not appear to be flow-limiting and was unchanged from the prior angiogram. Beyond the stent was an area of tortuosity followed by the mid vessel, which had a previous stent which was widely patent. Beyond the stent, in the later portion of the mid vessel, was an area of ectasia which was unchanged from the prior angiogram. The second diagonal branch arose from this area and had a 40-50% narrowing in its mid portion, which was unchanged from the prior angiogram. The distal portion of the left anterior descending in its course toward the apex had mild diffuse nonobstructive disease.
Left circumflex artery: The vessel had a previously placed stent in the mid vessel, which was widely patent. The second obtuse marginal branch was a medium to large caliber vessel which had 30% narrowing at its ostium and a focal 40-50% narrowing in the mid to distal portion, which was unchanged from the prior angiogram.
The third obtuse marginal branch had 30% diffuse narrowing.
Right coronary artery: The previously placed stent in the proximal and middle vessel had 20-30% diffuse mild in-stent re-stenosis. The distal vessel had 40-50% diffuse disease with a previously placed stent in the distal vessel widely patent. This was unchanged from the prior angiogram. An acute marginal branch arose from the mid vessel with an ostial 90% stenosis. This was a small caliber vessel, which was unchanged from the prior angiogram.
Left ventricle: Ejection fraction 65%. There were no wall motion abnormalities, mitral regurgitation, or aortic valve gradient. The left ventricular end diastolic pressure was 12.
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