---

INDICATIONS FOR PROCEDURE: The patient has presented with crushing-type substernal chest pain, even in the face of a normal nuclear medicine study. She is here for catheterization.

APPROACH: Right common femoral artery.

ANESTHESIA: IV sedation per cardiac catheterization protocol. Local sedation with 1% Xylocaine.

COMPLICATIONS: None.

ESTIMATED BLOOD LOSS: Less than 10 mL.

ESTIMATED CONTRAST: Less than 150 mL.

PROCEDURES PERFORMED: Left heart catheterization, left ventriculogram, selective coronary arteriography, aortic arch angiogram, right iliofemoral angiogram, #6 French Angio-Seal placement.

OPERATIVE TECHNIQUE: The patient was brought to the cardiac catheterization lab in the usual fasting state. She was placed supine on the cardiac catheterization table and the right groin was prepped and draped in the usual sterile fashion. One percent Xylocaine was infiltrated into the right femoral vessels. Next, a #6 French sheath was then placed in the right common femoral artery by the modified Seldinger technique.

SELECTIVE CORONARY ARTERIOGRAPHY: Next, right and left Judkins diagnostic catheters were advanced through their respective ostia and injected in multiple views.

LEFT VENTRICULOGRAM: Next, a pigtail catheter was advanced across the aortic valve and left ventricular pressure recorded. Next, an LV-gram was then performed with a hand injection of 50 mL of contrast. Next, pull-back pressure was measured across the aortic valve.

AORTA ARCH ANGIOGRAM: Next, aortic arch angiogram was then performed with injection of 50 mL of contrast at a rate of 20 mL/second to maximum pressure of 750 PSI performed in the 40-degree LAO view.

Next, right iliofemoral angiogram was performed in the 20-degree RAO view. Next Angio-Seal was applied successfully.

The patient left the cath lab without problems or issues.

DIAGNOSES: Left ventricular end-diastolic pressure was 18 mmHg. There was no gradient across the aortic valve. The central aortic pressure was 160 mmHg.

LEFT VENTRICULOGRAM: The left ventriculogram demonstrated normal LV systolic function with estimated ejection fraction greater than 50%.

AORTIC ARCH ANGIOGRAM: The aortic arch angiogram demonstrated normal aortic arch. No aortic regurgitation was seen.

SELECTIVE CORONARY ARTERIOGRAPHY: The right coronary artery is large and dominant.

The left main is patent.

The left anterior descending is patent.

The left circumflex is patent.

IMPRESSION: This study demonstrates normal coronary arteries in the presence of normal left ventricular systolic function. In addition, the aortic root is normal.

---