pvs network registry study · (hemitruncus) truncus arteriosus truncal valve insufficiency truncal...
TRANSCRIPT
PVS Network Registry Study
For the Retrospective study:
The PVS Network will concentrate the first data analysis on contemporary treatment practices and
outcomes.
We ask that data collection be prioritized to:
1. Children with PVS between 2010-2016
2. All children with two or more vein involved with PVS (common confluence=2veins)
3. Single vessel disease:
a. children who have had an intervention ( surgical/ cath) for single vessel PVS or
b. an echo diagnosis of PVS in 1 vein with a mean gradient > 4mmHg.
Our goal is to provide a general overview of the scope of PVS disease burden; therefore, we ask
institutions to search across many different databases, as these patients cross many different
disciplines.
Cardiology- palliative patients, routine follow up
Cardiac Surgery
Interventional Cardiology
Respirology/ lung transplant
Neonatology
*Helpful ways to identify children is through diagnostic code searches set up through the local IT
department.
REDCap Forms
PVS Registry overview
1. There is data that only requires one time entry - ie. Clinical or demographic data
2. There is data that requires repeating entry ie. Cardiac surgery; echos; CT or MRIs; catheter
interventions
At the end of many of the forms, there is an opportunity to upload the de-identified report. This is very
important because:
1. It helps with data verification
2. Data can be abstracted at Sickkids for the current study if there is not a dedicated
coordinator at the institution
3. These reports can be used to get more data for future studies if new variables are added
To become familiar with how to use the repeating events format of the PVS Network study, please look
at the link provided
REDCap Links:
https://projectredcap.org/resources/videos/
-specific to this project: • Repeating Instruments and Events (33 min)
This function allows a patient to have a record that may have 2 cardiac surgery entries; 3 pulmonary
vein interventions and 4 CT imaging entries. These can be added in a seamless and straightforward
manner.
Example:
Pulmonary Vein Stenosis:
General information about the disease and common tests can be found on the website.
www.pvsnetwork.org
06/04/2017 10:33am www.projectredcap.org
ConfidentialPVS registry
Page 1 of 140
Institutional enrollment
Record # __________________________________
INSTITUTIONAL ENROLLMENT
SECTION: ENROLLMENT
Enrollment date __________________________________
Participating centre Boston Children's Hospital (BCH)C.S Mott Children's Hospital (CSM)Cardinal Glennon Children's Hospital (CGC)Children's Clinics and Centers of Minnesota (CHM)Children's Hospital Colorado, Uptown Denver (DEN)Children's Hospital of Philadelphia (COP)Children's Hospital of Pittsburgh (CHP)Cincinnati Children's Hospital Medical Center (CCH)Emory Children's Hospital (EM)John Hopkins Children's Hospital (JH)Monroe Carell Jr. Children's Hospital atVanderbilt (VDB)Nemours Cardiac Center, Wilmington (NEM)New York-Presbyterian Morgan Stanley Children'sHospital (COL)Primary Children' Hospital, Utah (UT)Standford Children's Hospital (ST)Stollery Children's Hospital (SCH)Texas Children's Hospital (TE)The Hospital for Sick Children (SK)University of Iowa Children's Hospital (IOW)Washington University at St.Louis (WAS)
Type of data collection Retrospective protocol onlyProspective/ retrospective protocol
SECTION: GENETICS
Genetic study consent Yes(DNA or biospecimens) No
Source of child's DNA Prospective study consentExisting BiobankClinical genetics with research consent
Parental DNA available / collected Maternal DNAPaternal DNABothNone/not available/not collected
(Please assign DNA IDs accordingly (see below))
ID for mother's DNA: [recid]M
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 2 of 140
ID for father's DNA: [recid]F
Other biological specimens available Biobank- pulmonary vein tissueBiobank/pathology- parafin blocks/slidesBoth available
Comments on enrollment __________________________________________
06/04/2017 10:33am www.projectredcap.org
ConfidentialPVS registry
Page 3 of 140
Demographics and clinical
DEMOGRAPHICS AND CLINICAL INFORMATION
SECTION: DEMOGRAPHICS
Gender MaleFemale
Date of birth (year) __________________________________
Date of birth (month) JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
Birth weight (kg) __________________________________
Birth height (cm) __________________________________
Twin YesNo
Type of twin MonozygoticDizygoticUnknown
Comments on Twin type __________________________________________
Premature infant YesNo
If premature, weeks of gestation born __________________________________(if 35+1 (week+day), please enter '35')
Surfactant required NoYesUnknown
Intrauterine growth restriction NoYesUnknown
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 4 of 140
PDA treatment NoMedicalSurgicalUnknown
Abdominal pathology NoPneumotosis IntestinalisNecrotizing EnterocolitisUnknown
Total number of days intubated in NICU since birth __________________________________
History of treatment with systemic corticosteroids Nofor chronic lung disease Yes
Unknown
SECTION: DIAGNOSIS
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 5 of 140
Fundamental diagnosis PFOASD, SecundumASD, Sinus venosusASD, Coronary sinusASD, Common atrium (single atrium)ASD, Postoperative interatrial communicationVSD, Type 1 (Subarterial) (Supracristal) (Conalseptal defect) (Infundibular)VSD, Type 2 (Perimembranous) (Paramembranous)(Conoventricular)VSD, Type 3 (Inlet) (AV canal type)VSD, Type 4 (Muscular)VSD, Type: Gerbode type (LV-RA communication)VSD, MultipleAVC (AVSD), Complete (CAVSD)AVC (AVSD), Intermediate (transitional)AVC (AVSD), Partial (incomplete) (PAVSD) (ASD,primum)AP window (aortopulmonary window)Pulmonary artery origin from ascending aorta(hemitruncus)Truncus arteriosusTruncal valve insufficiencyTruncal valve stenosisTruncus arteriosus + Interrupted aortic archPartial anomalous pulmonary venous connection(PAPVC)Partial anomalous pulmonary venous connection(PAPVC), scimitarTotal anomalous pulmonary venous connection(TAPVC), Type1 (supracardiac)Total anomalous pulmonary venous connection(TAPVC), Type 2 (cardiac)Total anomalous pulmonary venous connection(TAPVC), Type 3 (infracardiac)Total anomalous pulmonary venous connection(TAPVC), Type 4 (mixed)Cor triatriatumPulmonary venous stenosisSystemic venous anomalySystemic venous obstructionTOFTOF, Pulmonary stenosisTOF, AVC (AVSD)TOF, Absent pulmonary valvePulmonary atresiaPulmonary atresia, IVSPulmonary atresia, VSD (Including TOF, PA)Pulmonary atresia, VSD-MAPCAMAPCA(s) (major aortopulmonary collateral[s])(without PA-VSD)Ebstein's anomalyTricuspid regurgitation, non-Ebstein's relatedTricuspid stenosisTricuspid regurgitation and tricuspid stenosisTricuspid valve, OtherPulmonary stenosis, ValvarPulmonary artery stenosis (hypoplasia), Main(trunk)Pulmonary artery stenosis, Branch, Central (withinthe hilar bifurcation)Pulmonary artery stenosis, Branch, Peripheral (ator beyond the hilar bifurcation)Pulmonary artery, DiscontinuousPulmonary stenosis, SubvalvarDCRVPulmonary valve, OtherPulmonary insufficiencyPulmonary insufficiency and pulmonary stenosisShunt Failure
Conduit failureAortic stenosis, SubvalvarAortic stenosis, ValvarAortic stenosis, SupravalvarAortic valve atresiaAortic insufficiencyAortic insufficiency and aortic stenosisAortic valve, OtherSinus of Valsalva aneurysmLV to aorta tunnelMitral stenosis, Supravalvar mitral ringMitral stenosis, ValvarMitral stenosis, SubvalvarMitral stenosis, Subvalvar, ParachuteMitral stenosisMitral regurgitation and mitral stenosisMitral regurgitationMitral valve, OtherHypoplastic left heart syndrome (HLHS)Shone's syndromeCardiomyopathy (including dilated, restrictive,and hypertrophic)Cardiomyopathy, End-stage congenital heart diseasePericardial effusionPericarditisPericardial disease, OtherSingle ventricle, DILVSingle ventricle, DIRVSingle ventricle, Mitral atresiaSingle ventricle, Tricuspid atresiaSingle ventricle, Unbalanced AV canalSingle ventricle, Heterotaxia syndromeSingle ventricle, OtherSingle ventricle + Total anomalous pulmonaryvenous connection (TAPVC)Congenitally corrected TGACongenitally corrected TGA, IVSCongenitally corrected TGA, IVS-LVOTOCongenitally corrected TGA, VSDCongenitally corrected TGA, VSD-LVOTOTGA, IVSTGA, IVS-LVOTOTGA, VSDTGA, VSD-LVOTODORV, VSD typeDORV, TOF typeDORV, TGA typeDORV, Remote VSD (uncommitted VSD)DORV + AVSD (AV Canal)DORV, IVSDOLVCoarctation of aortaAortic arch hypoplasiaVSD + Aortic arch hypoplasiaVSD + Coarctation of aortaCoronary artery anomaly, Anomalous aortic originof coronary artery (AAOCA)Coronary artery anomaly, Anomalous pulmonaryorigin (includes ALCAPA)Coronary artery anomaly, FistulaCoronary artery anomaly, AneurysmCoronary artery anomaly, Ostial atresiaCoronary artery anomaly, OtherInterrupted aortic archInterrupted aortic arch + VSDInterrupted aortic arch + AP window(aortopulmonary window)Patent ductus arteriosusVascular ringPulmonary artery slingAortic aneurysm (including pseudoaneurysm)
Aortic dissectionLung disease, BenignLung disease, MalignantTracheal stenosisTracheomalaciaAirway diseasePleural disease, BenignPleural disease, MalignantPneumothoraxPleural effusionChylothoraxEmpyemaEsophageal disease, BenignEsophageal disease, MalignantMediastinal diseaseMediastinal disease, BenignMediastinal disease, MalignantDiaphragm paralysisDiaphragm disease, OtherRib tumor, BenignRib tumor, MalignantRib tumor, MetastaticSternal tumor, BenignSternal tumor, MalignantSternal tumor, MetastaticPectus carinatumPectus excavatumThoracic outlet syndromeArrhythmiaArrhythmia, Atrial, Atrial fibrillationArrhythmia, Atrial, Atrial flutterArrhythmia, Atrial, OtherArrhythmia, JunctionalArrhythmia, VentricularArrhythmia, Heart blockArrhythmia, Heart block, AcquiredArrhythmia, Heart block, CongenitalArrhythmia, Pacemaker, Indication for replacementAtrial Isomerism, LeftAtrial Isomerism, RightDextrocardiaLevocardiaMesocardiaSitus inversusAneurysm, Ventricular, Right (includingpseudoaneurysm)Aneurysm, Ventricular, Left (includingpseudoaneurysm)Aneurysm, Pulmonary arteryAneurysm, OtherHypoplastic RVHypoplastic LVPostoperative bleedingMediastinitisEndocarditisRheumatic heart diseaseProsthetic valve failureMyocardial infarctionCardiac tumorPulmonary AV fistulaPulmonary embolismPulmonary vascular obstructive diseasePulmonary vascular obstructive disease(Eisenmenger's)Primary pulmonary hypertensionPersistent fetal circulationMeconium aspirationKawasaki DiseaseCardiac, OtherThoracic and/or mediastinal, OtherPeripheral vascular, Other
Complication of cardiovascular catheterizationprocedureComplication of cardiovascular catheterizationprocedure, Device embolizationComplication of cardiovascular catheterizationprocedure, Device malfunctionComplication of cardiovascular catheterizationprocedure, PerforationComplication of interventional radiology procedureComplication of interventional radiologyprocedure, Device embolizationComplication of interventional radiologyprocedure, Device malfunctionComplication of interventional radiologyprocedure, PerforationForeign body, Intracardiac foreign bodyForeign body, Intravascular foreign bodyOpen sternum with closed skinOpen sternum with open skin (includes membraneplaced to close skin)Retained sternal wire causing irritationSyncopeTrauma, BluntTrauma, PenetratingNormal heartMiscellaneous, Other
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 9 of 140
Secondary diagnosis 1 NonePFOASD, SecundumASD, Sinus venosusASD, Coronary sinusASD, Common atrium (single atrium)ASD, Postoperative interatrial communicationVSD, Type 1 (Subarterial) (Supracristal) (Conalseptal defect) (Infundibular)VSD, Type 2 (Perimembranous) (Paramembranous)(Conoventricular)VSD, Type 3 (Inlet) (AV canal type)VSD, Type 4 (Muscular)VSD, Type: Gerbode type (LV-RA communication)VSD, MultipleAVC (AVSD), Complete (CAVSD)AVC (AVSD), Intermediate (transitional)AVC (AVSD), Partial (incomplete) (PAVSD) (ASD,primum)AP window (aortopulmonary window)Pulmonary artery origin from ascending aorta(hemitruncus)Truncus arteriosusTruncal valve insufficiencyTruncal valve stenosisTruncus arteriosus + Interrupted aortic archPartial anomalous pulmonary venous connection(PAPVC)Partial anomalous pulmonary venous connection(PAPVC), scimitarTotal anomalous pulmonary venous connection(TAPVC), Type1 (supracardiac)Total anomalous pulmonary venous connection(TAPVC), Type 2 (cardiac)Total anomalous pulmonary venous connection(TAPVC), Type 3 (infracardiac)Total anomalous pulmonary venous connection(TAPVC), Type 4 (mixed)Cor triatriatumPulmonary venous stenosisSystemic venous anomalySystemic venous obstructionTOFTOF, Pulmonary stenosisTOF, AVC (AVSD)TOF, Absent pulmonary valvePulmonary atresiaPulmonary atresia, IVSPulmonary atresia, VSD (Including TOF, PA)Pulmonary atresia, VSD-MAPCAMAPCA(s) (major aortopulmonary collateral[s])(without PA-VSD)Ebstein's anomalyTricuspid regurgitation, non-Ebstein's relatedTricuspid stenosisTricuspid regurgitation and tricuspid stenosisTricuspid valve, OtherPulmonary stenosis, ValvarPulmonary artery stenosis (hypoplasia), Main(trunk)Pulmonary artery stenosis, Branch, Central (withinthe hilar bifurcation)Pulmonary artery stenosis, Branch, Peripheral (ator beyond the hilar bifurcation)Pulmonary artery, DiscontinuousPulmonary stenosis, SubvalvarDCRVPulmonary valve, OtherPulmonary insufficiencyPulmonary insufficiency and pulmonary stenosis
Shunt FailureConduit failureAortic stenosis, SubvalvarAortic stenosis, ValvarAortic stenosis, SupravalvarAortic valve atresiaAortic insufficiencyAortic insufficiency and aortic stenosisAortic valve, OtherSinus of Valsalva aneurysmLV to aorta tunnelMitral stenosis, Supravalvar mitral ringMitral stenosis, ValvarMitral stenosis, SubvalvarMitral stenosis, Subvalvar, ParachuteMitral stenosisMitral regurgitation and mitral stenosisMitral regurgitationMitral valve, OtherHypoplastic left heart syndrome (HLHS)Shone's syndromeCardiomyopathy (including dilated, restrictive,and hypertrophic)Cardiomyopathy, End-stage congenital heart diseasePericardial effusionPericarditisPericardial disease, OtherSingle ventricle, DILVSingle ventricle, DIRVSingle ventricle, Mitral atresiaSingle ventricle, Tricuspid atresiaSingle ventricle, Unbalanced AV canalSingle ventricle, Heterotaxia syndromeSingle ventricle, OtherSingle ventricle + Total anomalous pulmonaryvenous connection (TAPVC)Congenitally corrected TGACongenitally corrected TGA, IVSCongenitally corrected TGA, IVS-LVOTOCongenitally corrected TGA, VSDCongenitally corrected TGA, VSD-LVOTOTGA, IVSTGA, IVS-LVOTOTGA, VSDTGA, VSD-LVOTODORV, VSD typeDORV, TOF typeDORV, TGA typeDORV, Remote VSD (uncommitted VSD)DORV + AVSD (AV Canal)DORV, IVSDOLVCoarctation of aortaAortic arch hypoplasiaVSD + Aortic arch hypoplasiaVSD + Coarctation of aortaCoronary artery anomaly, Anomalous aortic originof coronary artery (AAOCA)Coronary artery anomaly, Anomalous pulmonaryorigin (includes ALCAPA)Coronary artery anomaly, FistulaCoronary artery anomaly, AneurysmCoronary artery anomaly, Ostial atresiaCoronary artery anomaly, OtherInterrupted aortic archInterrupted aortic arch + VSDInterrupted aortic arch + AP window(aortopulmonary window)Patent ductus arteriosusVascular ringPulmonary artery sling
Aortic aneurysm (including pseudoaneurysm)Aortic dissectionLung disease, BenignLung disease, MalignantTracheal stenosisTracheomalaciaAirway diseasePleural disease, BenignPleural disease, MalignantPneumothoraxPleural effusionChylothoraxEmpyemaEsophageal disease, BenignEsophageal disease, MalignantMediastinal diseaseMediastinal disease, BenignMediastinal disease, MalignantDiaphragm paralysisDiaphragm disease, OtherRib tumor, BenignRib tumor, MalignantRib tumor, MetastaticSternal tumor, BenignSternal tumor, MalignantSternal tumor, MetastaticPectus carinatumPectus excavatumThoracic outlet syndromeArrhythmiaArrhythmia, Atrial, Atrial fibrillationArrhythmia, Atrial, Atrial flutterArrhythmia, Atrial, OtherArrhythmia, JunctionalArrhythmia, VentricularArrhythmia, Heart blockArrhythmia, Heart block, AcquiredArrhythmia, Heart block, CongenitalArrhythmia, Pacemaker, Indication for replacementAtrial Isomerism, LeftAtrial Isomerism, RightDextrocardiaLevocardiaMesocardiaSitus inversusAneurysm, Ventricular, Right (includingpseudoaneurysm)Aneurysm, Ventricular, Left (includingpseudoaneurysm)Aneurysm, Pulmonary arteryAneurysm, OtherHypoplastic RVHypoplastic LVPostoperative bleedingMediastinitisEndocarditisRheumatic heart diseaseProsthetic valve failureMyocardial infarctionCardiac tumorPulmonary AV fistulaPulmonary embolismPulmonary vascular obstructive diseasePulmonary vascular obstructive disease(Eisenmenger's)Primary pulmonary hypertensionPersistent fetal circulationMeconium aspirationKawasaki DiseaseCardiac, OtherThoracic and/or mediastinal, Other
Peripheral vascular, OtherComplication of cardiovascular catheterizationprocedureComplication of cardiovascular catheterizationprocedure, Device embolizationComplication of cardiovascular catheterizationprocedure, Device malfunctionComplication of cardiovascular catheterizationprocedure, PerforationComplication of interventional radiology procedureComplication of interventional radiologyprocedure, Device embolizationComplication of interventional radiologyprocedure, Device malfunctionComplication of interventional radiologyprocedure, PerforationForeign body, Intracardiac foreign bodyForeign body, Intravascular foreign bodyOpen sternum with closed skinOpen sternum with open skin (includes membraneplaced to close skin)Retained sternal wire causing irritationSyncopeTrauma, BluntTrauma, PenetratingNormal heartMiscellaneous, Other
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 13 of 140
Secondary diagnosis 2 NonePFOASD, SecundumASD, Sinus venosusASD, Coronary sinusASD, Common atrium (single atrium)ASD, Postoperative interatrial communicationVSD, Type 1 (Subarterial) (Supracristal) (Conalseptal defect) (Infundibular)VSD, Type 2 (Perimembranous) (Paramembranous)(Conoventricular)VSD, Type 3 (Inlet) (AV canal type)VSD, Type 4 (Muscular)VSD, Type: Gerbode type (LV-RA communication)VSD, MultipleAVC (AVSD), Complete (CAVSD)AVC (AVSD), Intermediate (transitional)AVC (AVSD), Partial (incomplete) (PAVSD) (ASD,primum)AP window (aortopulmonary window)Pulmonary artery origin from ascending aorta(hemitruncus)Truncus arteriosusTruncal valve insufficiencyTruncal valve stenosisTruncus arteriosus + Interrupted aortic archPartial anomalous pulmonary venous connection(PAPVC)Partial anomalous pulmonary venous connection(PAPVC), scimitarTotal anomalous pulmonary venous connection(TAPVC), Type1 (supracardiac)Total anomalous pulmonary venous connection(TAPVC), Type 2 (cardiac)Total anomalous pulmonary venous connection(TAPVC), Type 3 (infracardiac)Total anomalous pulmonary venous connection(TAPVC), Type 4 (mixed)Cor triatriatumPulmonary venous stenosisSystemic venous anomalySystemic venous obstructionTOFTOF, Pulmonary stenosisTOF, AVC (AVSD)TOF, Absent pulmonary valvePulmonary atresiaPulmonary atresia, IVSPulmonary atresia, VSD (Including TOF, PA)Pulmonary atresia, VSD-MAPCAMAPCA(s) (major aortopulmonary collateral[s])(without PA-VSD)Ebstein's anomalyTricuspid regurgitation, non-Ebstein's relatedTricuspid stenosisTricuspid regurgitation and tricuspid stenosisTricuspid valve, OtherPulmonary stenosis, ValvarPulmonary artery stenosis (hypoplasia), Main(trunk)Pulmonary artery stenosis, Branch, Central (withinthe hilar bifurcation)Pulmonary artery stenosis, Branch, Peripheral (ator beyond the hilar bifurcation)Pulmonary artery, DiscontinuousPulmonary stenosis, SubvalvarDCRVPulmonary valve, OtherPulmonary insufficiencyPulmonary insufficiency and pulmonary stenosis
Shunt FailureConduit failureAortic stenosis, SubvalvarAortic stenosis, ValvarAortic stenosis, SupravalvarAortic valve atresiaAortic insufficiencyAortic insufficiency and aortic stenosisAortic valve, OtherSinus of Valsalva aneurysmLV to aorta tunnelMitral stenosis, Supravalvar mitral ringMitral stenosis, ValvarMitral stenosis, SubvalvarMitral stenosis, Subvalvar, ParachuteMitral stenosisMitral regurgitation and mitral stenosisMitral regurgitationMitral valve, OtherHypoplastic left heart syndrome (HLHS)Shone's syndromeCardiomyopathy (including dilated, restrictive,and hypertrophic)Cardiomyopathy, End-stage congenital heart diseasePericardial effusionPericarditisPericardial disease, OtherSingle ventricle, DILVSingle ventricle, DIRVSingle ventricle, Mitral atresiaSingle ventricle, Tricuspid atresiaSingle ventricle, Unbalanced AV canalSingle ventricle, Heterotaxia syndromeSingle ventricle, OtherSingle ventricle + Total anomalous pulmonaryvenous connection (TAPVC)Congenitally corrected TGACongenitally corrected TGA, IVSCongenitally corrected TGA, IVS-LVOTOCongenitally corrected TGA, VSDCongenitally corrected TGA, VSD-LVOTOTGA, IVSTGA, IVS-LVOTOTGA, VSDTGA, VSD-LVOTODORV, VSD typeDORV, TOF typeDORV, TGA typeDORV, Remote VSD (uncommitted VSD)DORV + AVSD (AV Canal)DORV, IVSDOLVCoarctation of aortaAortic arch hypoplasiaVSD + Aortic arch hypoplasiaVSD + Coarctation of aortaCoronary artery anomaly, Anomalous aortic originof coronary artery (AAOCA)Coronary artery anomaly, Anomalous pulmonaryorigin (includes ALCAPA)Coronary artery anomaly, FistulaCoronary artery anomaly, AneurysmCoronary artery anomaly, Ostial atresiaCoronary artery anomaly, OtherInterrupted aortic archInterrupted aortic arch + VSDInterrupted aortic arch + AP window(aortopulmonary window)Patent ductus arteriosusVascular ringPulmonary artery sling
Aortic aneurysm (including pseudoaneurysm)Aortic dissectionLung disease, BenignLung disease, MalignantTracheal stenosisTracheomalaciaAirway diseasePleural disease, BenignPleural disease, MalignantPneumothoraxPleural effusionChylothoraxEmpyemaEsophageal disease, BenignEsophageal disease, MalignantMediastinal diseaseMediastinal disease, BenignMediastinal disease, MalignantDiaphragm paralysisDiaphragm disease, OtherRib tumor, BenignRib tumor, MalignantRib tumor, MetastaticSternal tumor, BenignSternal tumor, MalignantSternal tumor, MetastaticPectus carinatumPectus excavatumThoracic outlet syndromeArrhythmiaArrhythmia, Atrial, Atrial fibrillationArrhythmia, Atrial, Atrial flutterArrhythmia, Atrial, OtherArrhythmia, JunctionalArrhythmia, VentricularArrhythmia, Heart blockArrhythmia, Heart block, AcquiredArrhythmia, Heart block, CongenitalArrhythmia, Pacemaker, Indication for replacementAtrial Isomerism, LeftAtrial Isomerism, RightDextrocardiaLevocardiaMesocardiaSitus inversusAneurysm, Ventricular, Right (includingpseudoaneurysm)Aneurysm, Ventricular, Left (includingpseudoaneurysm)Aneurysm, Pulmonary arteryAneurysm, OtherHypoplastic RVHypoplastic LVPostoperative bleedingMediastinitisEndocarditisRheumatic heart diseaseProsthetic valve failureMyocardial infarctionCardiac tumorPulmonary AV fistulaPulmonary embolismPulmonary vascular obstructive diseasePulmonary vascular obstructive disease(Eisenmenger's)Primary pulmonary hypertensionPersistent fetal circulationMeconium aspirationKawasaki DiseaseCardiac, OtherThoracic and/or mediastinal, Other
Peripheral vascular, OtherComplication of cardiovascular catheterizationprocedureComplication of cardiovascular catheterizationprocedure, Device embolizationComplication of cardiovascular catheterizationprocedure, Device malfunctionComplication of cardiovascular catheterizationprocedure, PerforationComplication of interventional radiology procedureComplication of interventional radiologyprocedure, Device embolizationComplication of interventional radiologyprocedure, Device malfunctionComplication of interventional radiologyprocedure, PerforationForeign body, Intracardiac foreign bodyForeign body, Intravascular foreign bodyOpen sternum with closed skinOpen sternum with open skin (includes membraneplaced to close skin)Retained sternal wire causing irritationSyncopeTrauma, BluntTrauma, PenetratingNormal heartMiscellaneous, Other
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 17 of 140
Secondary diagnosis 3 NonePFOASD, SecundumASD, Sinus venosusASD, Coronary sinusASD, Common atrium (single atrium)ASD, Postoperative interatrial communicationVSD, Type 1 (Subarterial) (Supracristal) (Conalseptal defect) (Infundibular)VSD, Type 2 (Perimembranous) (Paramembranous)(Conoventricular)VSD, Type 3 (Inlet) (AV canal type)VSD, Type 4 (Muscular)VSD, Type: Gerbode type (LV-RA communication)VSD, MultipleAVC (AVSD), Complete (CAVSD)AVC (AVSD), Intermediate (transitional)AVC (AVSD), Partial (incomplete) (PAVSD) (ASD,primum)AP window (aortopulmonary window)Pulmonary artery origin from ascending aorta(hemitruncus)Truncus arteriosusTruncal valve insufficiencyTruncal valve stenosisTruncus arteriosus + Interrupted aortic archPartial anomalous pulmonary venous connection(PAPVC)Partial anomalous pulmonary venous connection(PAPVC), scimitarTotal anomalous pulmonary venous connection(TAPVC), Type1 (supracardiac)Total anomalous pulmonary venous connection(TAPVC), Type 2 (cardiac)Total anomalous pulmonary venous connection(TAPVC), Type 3 (infracardiac)Total anomalous pulmonary venous connection(TAPVC), Type 4 (mixed)Cor triatriatumPulmonary venous stenosisSystemic venous anomalySystemic venous obstructionTOFTOF, Pulmonary stenosisTOF, AVC (AVSD)TOF, Absent pulmonary valvePulmonary atresiaPulmonary atresia, IVSPulmonary atresia, VSD (Including TOF, PA)Pulmonary atresia, VSD-MAPCAMAPCA(s) (major aortopulmonary collateral[s])(without PA-VSD)Ebstein's anomalyTricuspid regurgitation, non-Ebstein's relatedTricuspid stenosisTricuspid regurgitation and tricuspid stenosisTricuspid valve, OtherPulmonary stenosis, ValvarPulmonary artery stenosis (hypoplasia), Main(trunk)Pulmonary artery stenosis, Branch, Central (withinthe hilar bifurcation)Pulmonary artery stenosis, Branch, Peripheral (ator beyond the hilar bifurcation)Pulmonary artery, DiscontinuousPulmonary stenosis, SubvalvarDCRVPulmonary valve, OtherPulmonary insufficiencyPulmonary insufficiency and pulmonary stenosis
Shunt FailureConduit failureAortic stenosis, SubvalvarAortic stenosis, ValvarAortic stenosis, SupravalvarAortic valve atresiaAortic insufficiencyAortic insufficiency and aortic stenosisAortic valve, OtherSinus of Valsalva aneurysmLV to aorta tunnelMitral stenosis, Supravalvar mitral ringMitral stenosis, ValvarMitral stenosis, SubvalvarMitral stenosis, Subvalvar, ParachuteMitral stenosisMitral regurgitation and mitral stenosisMitral regurgitationMitral valve, OtherHypoplastic left heart syndrome (HLHS)Shone's syndromeCardiomyopathy (including dilated, restrictive,and hypertrophic)Cardiomyopathy, End-stage congenital heart diseasePericardial effusionPericarditisPericardial disease, OtherSingle ventricle, DILVSingle ventricle, DIRVSingle ventricle, Mitral atresiaSingle ventricle, Tricuspid atresiaSingle ventricle, Unbalanced AV canalSingle ventricle, Heterotaxia syndromeSingle ventricle, OtherSingle ventricle + Total anomalous pulmonaryvenous connection (TAPVC)Congenitally corrected TGACongenitally corrected TGA, IVSCongenitally corrected TGA, IVS-LVOTOCongenitally corrected TGA, VSDCongenitally corrected TGA, VSD-LVOTOTGA, IVSTGA, IVS-LVOTOTGA, VSDTGA, VSD-LVOTODORV, VSD typeDORV, TOF typeDORV, TGA typeDORV, Remote VSD (uncommitted VSD)DORV + AVSD (AV Canal)DORV, IVSDOLVCoarctation of aortaAortic arch hypoplasiaVSD + Aortic arch hypoplasiaVSD + Coarctation of aortaCoronary artery anomaly, Anomalous aortic originof coronary artery (AAOCA)Coronary artery anomaly, Anomalous pulmonaryorigin (includes ALCAPA)Coronary artery anomaly, FistulaCoronary artery anomaly, AneurysmCoronary artery anomaly, Ostial atresiaCoronary artery anomaly, OtherInterrupted aortic archInterrupted aortic arch + VSDInterrupted aortic arch + AP window(aortopulmonary window)Patent ductus arteriosusVascular ringPulmonary artery sling
Aortic aneurysm (including pseudoaneurysm)Aortic dissectionLung disease, BenignLung disease, MalignantTracheal stenosisTracheomalaciaAirway diseasePleural disease, BenignPleural disease, MalignantPneumothoraxPleural effusionChylothoraxEmpyemaEsophageal disease, BenignEsophageal disease, MalignantMediastinal diseaseMediastinal disease, BenignMediastinal disease, MalignantDiaphragm paralysisDiaphragm disease, OtherRib tumor, BenignRib tumor, MalignantRib tumor, MetastaticSternal tumor, BenignSternal tumor, MalignantSternal tumor, MetastaticPectus carinatumPectus excavatumThoracic outlet syndromeArrhythmiaArrhythmia, Atrial, Atrial fibrillationArrhythmia, Atrial, Atrial flutterArrhythmia, Atrial, OtherArrhythmia, JunctionalArrhythmia, VentricularArrhythmia, Heart blockArrhythmia, Heart block, AcquiredArrhythmia, Heart block, CongenitalArrhythmia, Pacemaker, Indication for replacementAtrial Isomerism, LeftAtrial Isomerism, RightDextrocardiaLevocardiaMesocardiaSitus inversusAneurysm, Ventricular, Right (includingpseudoaneurysm)Aneurysm, Ventricular, Left (includingpseudoaneurysm)Aneurysm, Pulmonary arteryAneurysm, OtherHypoplastic RVHypoplastic LVPostoperative bleedingMediastinitisEndocarditisRheumatic heart diseaseProsthetic valve failureMyocardial infarctionCardiac tumorPulmonary AV fistulaPulmonary embolismPulmonary vascular obstructive diseasePulmonary vascular obstructive disease(Eisenmenger's)Primary pulmonary hypertensionPersistent fetal circulationMeconium aspirationKawasaki DiseaseCardiac, OtherThoracic and/or mediastinal, Other
Peripheral vascular, OtherComplication of cardiovascular catheterizationprocedureComplication of cardiovascular catheterizationprocedure, Device embolizationComplication of cardiovascular catheterizationprocedure, Device malfunctionComplication of cardiovascular catheterizationprocedure, PerforationComplication of interventional radiology procedureComplication of interventional radiologyprocedure, Device embolizationComplication of interventional radiologyprocedure, Device malfunctionComplication of interventional radiologyprocedure, PerforationForeign body, Intracardiac foreign bodyForeign body, Intravascular foreign bodyOpen sternum with closed skinOpen sternum with open skin (includes membraneplaced to close skin)Retained sternal wire causing irritationSyncopeTrauma, BluntTrauma, PenetratingNormal heartMiscellaneous, Other
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 21 of 140
Secondary diagnosis 4 NonePFOASD, SecundumASD, Sinus venosusASD, Coronary sinusASD, Common atrium (single atrium)ASD, Postoperative interatrial communicationVSD, Type 1 (Subarterial) (Supracristal) (Conalseptal defect) (Infundibular)VSD, Type 2 (Perimembranous) (Paramembranous)(Conoventricular)VSD, Type 3 (Inlet) (AV canal type)VSD, Type 4 (Muscular)VSD, Type: Gerbode type (LV-RA communication)VSD, MultipleAVC (AVSD), Complete (CAVSD)AVC (AVSD), Intermediate (transitional)AVC (AVSD), Partial (incomplete) (PAVSD) (ASD,primum)AP window (aortopulmonary window)Pulmonary artery origin from ascending aorta(hemitruncus)Truncus arteriosusTruncal valve insufficiencyTruncal valve stenosisTruncus arteriosus + Interrupted aortic archPartial anomalous pulmonary venous connection(PAPVC)Partial anomalous pulmonary venous connection(PAPVC), scimitarTotal anomalous pulmonary venous connection(TAPVC), Type1 (supracardiac)Total anomalous pulmonary venous connection(TAPVC), Type 2 (cardiac)Total anomalous pulmonary venous connection(TAPVC), Type 3 (infracardiac)Total anomalous pulmonary venous connection(TAPVC), Type 4 (mixed)Cor triatriatumPulmonary venous stenosisSystemic venous anomalySystemic venous obstructionTOFTOF, Pulmonary stenosisTOF, AVC (AVSD)TOF, Absent pulmonary valvePulmonary atresiaPulmonary atresia, IVSPulmonary atresia, VSD (Including TOF, PA)Pulmonary atresia, VSD-MAPCAMAPCA(s) (major aortopulmonary collateral[s])(without PA-VSD)Ebstein's anomalyTricuspid regurgitation, non-Ebstein's relatedTricuspid stenosisTricuspid regurgitation and tricuspid stenosisTricuspid valve, OtherPulmonary stenosis, ValvarPulmonary artery stenosis (hypoplasia), Main(trunk)Pulmonary artery stenosis, Branch, Central (withinthe hilar bifurcation)Pulmonary artery stenosis, Branch, Peripheral (ator beyond the hilar bifurcation)Pulmonary artery, DiscontinuousPulmonary stenosis, SubvalvarDCRVPulmonary valve, OtherPulmonary insufficiencyPulmonary insufficiency and pulmonary stenosis
Shunt FailureConduit failureAortic stenosis, SubvalvarAortic stenosis, ValvarAortic stenosis, SupravalvarAortic valve atresiaAortic insufficiencyAortic insufficiency and aortic stenosisAortic valve, OtherSinus of Valsalva aneurysmLV to aorta tunnelMitral stenosis, Supravalvar mitral ringMitral stenosis, ValvarMitral stenosis, SubvalvarMitral stenosis, Subvalvar, ParachuteMitral stenosisMitral regurgitation and mitral stenosisMitral regurgitationMitral valve, OtherHypoplastic left heart syndrome (HLHS)Shone's syndromeCardiomyopathy (including dilated, restrictive,and hypertrophic)Cardiomyopathy, End-stage congenital heart diseasePericardial effusionPericarditisPericardial disease, OtherSingle ventricle, DILVSingle ventricle, DIRVSingle ventricle, Mitral atresiaSingle ventricle, Tricuspid atresiaSingle ventricle, Unbalanced AV canalSingle ventricle, Heterotaxia syndromeSingle ventricle, OtherSingle ventricle + Total anomalous pulmonaryvenous connection (TAPVC)Congenitally corrected TGACongenitally corrected TGA, IVSCongenitally corrected TGA, IVS-LVOTOCongenitally corrected TGA, VSDCongenitally corrected TGA, VSD-LVOTOTGA, IVSTGA, IVS-LVOTOTGA, VSDTGA, VSD-LVOTODORV, VSD typeDORV, TOF typeDORV, TGA typeDORV, Remote VSD (uncommitted VSD)DORV + AVSD (AV Canal)DORV, IVSDOLVCoarctation of aortaAortic arch hypoplasiaVSD + Aortic arch hypoplasiaVSD + Coarctation of aortaCoronary artery anomaly, Anomalous aortic originof coronary artery (AAOCA)Coronary artery anomaly, Anomalous pulmonaryorigin (includes ALCAPA)Coronary artery anomaly, FistulaCoronary artery anomaly, AneurysmCoronary artery anomaly, Ostial atresiaCoronary artery anomaly, OtherInterrupted aortic archInterrupted aortic arch + VSDInterrupted aortic arch + AP window(aortopulmonary window)Patent ductus arteriosusVascular ringPulmonary artery sling
Aortic aneurysm (including pseudoaneurysm)Aortic dissectionLung disease, BenignLung disease, MalignantTracheal stenosisTracheomalaciaAirway diseasePleural disease, BenignPleural disease, MalignantPneumothoraxPleural effusionChylothoraxEmpyemaEsophageal disease, BenignEsophageal disease, MalignantMediastinal diseaseMediastinal disease, BenignMediastinal disease, MalignantDiaphragm paralysisDiaphragm disease, OtherRib tumor, BenignRib tumor, MalignantRib tumor, MetastaticSternal tumor, BenignSternal tumor, MalignantSternal tumor, MetastaticPectus carinatumPectus excavatumThoracic outlet syndromeArrhythmiaArrhythmia, Atrial, Atrial fibrillationArrhythmia, Atrial, Atrial flutterArrhythmia, Atrial, OtherArrhythmia, JunctionalArrhythmia, VentricularArrhythmia, Heart blockArrhythmia, Heart block, AcquiredArrhythmia, Heart block, CongenitalArrhythmia, Pacemaker, Indication for replacementAtrial Isomerism, LeftAtrial Isomerism, RightDextrocardiaLevocardiaMesocardiaSitus inversusAneurysm, Ventricular, Right (includingpseudoaneurysm)Aneurysm, Ventricular, Left (includingpseudoaneurysm)Aneurysm, Pulmonary arteryAneurysm, OtherHypoplastic RVHypoplastic LVPostoperative bleedingMediastinitisEndocarditisRheumatic heart diseaseProsthetic valve failureMyocardial infarctionCardiac tumorPulmonary AV fistulaPulmonary embolismPulmonary vascular obstructive diseasePulmonary vascular obstructive disease(Eisenmenger's)Primary pulmonary hypertensionPersistent fetal circulationMeconium aspirationKawasaki DiseaseCardiac, OtherThoracic and/or mediastinal, Other
Peripheral vascular, OtherComplication of cardiovascular catheterizationprocedureComplication of cardiovascular catheterizationprocedure, Device embolizationComplication of cardiovascular catheterizationprocedure, Device malfunctionComplication of cardiovascular catheterizationprocedure, PerforationComplication of interventional radiology procedureComplication of interventional radiologyprocedure, Device embolizationComplication of interventional radiologyprocedure, Device malfunctionComplication of interventional radiologyprocedure, PerforationForeign body, Intracardiac foreign bodyForeign body, Intravascular foreign bodyOpen sternum with closed skinOpen sternum with open skin (includes membraneplaced to close skin)Retained sternal wire causing irritationSyncopeTrauma, BluntTrauma, PenetratingNormal heartMiscellaneous, Other
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 25 of 140
Secondary diagnosis 5 NonePFOASD, SecundumASD, Sinus venosusASD, Coronary sinusASD, Common atrium (single atrium)ASD, Postoperative interatrial communicationVSD, Type 1 (Subarterial) (Supracristal) (Conalseptal defect) (Infundibular)VSD, Type 2 (Perimembranous) (Paramembranous)(Conoventricular)VSD, Type 3 (Inlet) (AV canal type)VSD, Type 4 (Muscular)VSD, Type: Gerbode type (LV-RA communication)VSD, MultipleAVC (AVSD), Complete (CAVSD)AVC (AVSD), Intermediate (transitional)AVC (AVSD), Partial (incomplete) (PAVSD) (ASD,primum)AP window (aortopulmonary window)Pulmonary artery origin from ascending aorta(hemitruncus)Truncus arteriosusTruncal valve insufficiencyTruncal valve stenosisTruncus arteriosus + Interrupted aortic archPartial anomalous pulmonary venous connection(PAPVC)Partial anomalous pulmonary venous connection(PAPVC), scimitarTotal anomalous pulmonary venous connection(TAPVC), Type1 (supracardiac)Total anomalous pulmonary venous connection(TAPVC), Type 2 (cardiac)Total anomalous pulmonary venous connection(TAPVC), Type 3 (infracardiac)Total anomalous pulmonary venous connection(TAPVC), Type 4 (mixed)Cor triatriatumPulmonary venous stenosisSystemic venous anomalySystemic venous obstructionTOFTOF, Pulmonary stenosisTOF, AVC (AVSD)TOF, Absent pulmonary valvePulmonary atresiaPulmonary atresia, IVSPulmonary atresia, VSD (Including TOF, PA)Pulmonary atresia, VSD-MAPCAMAPCA(s) (major aortopulmonary collateral[s])(without PA-VSD)Ebstein's anomalyTricuspid regurgitation, non-Ebstein's relatedTricuspid stenosisTricuspid regurgitation and tricuspid stenosisTricuspid valve, OtherPulmonary stenosis, ValvarPulmonary artery stenosis (hypoplasia), Main(trunk)Pulmonary artery stenosis, Branch, Central (withinthe hilar bifurcation)Pulmonary artery stenosis, Branch, Peripheral (ator beyond the hilar bifurcation)Pulmonary artery, DiscontinuousPulmonary stenosis, SubvalvarDCRVPulmonary valve, OtherPulmonary insufficiencyPulmonary insufficiency and pulmonary stenosis
Shunt FailureConduit failureAortic stenosis, SubvalvarAortic stenosis, ValvarAortic stenosis, SupravalvarAortic valve atresiaAortic insufficiencyAortic insufficiency and aortic stenosisAortic valve, OtherSinus of Valsalva aneurysmLV to aorta tunnelMitral stenosis, Supravalvar mitral ringMitral stenosis, ValvarMitral stenosis, SubvalvarMitral stenosis, Subvalvar, ParachuteMitral stenosisMitral regurgitation and mitral stenosisMitral regurgitationMitral valve, OtherHypoplastic left heart syndrome (HLHS)Shone's syndromeCardiomyopathy (including dilated, restrictive,and hypertrophic)Cardiomyopathy, End-stage congenital heart diseasePericardial effusionPericarditisPericardial disease, OtherSingle ventricle, DILVSingle ventricle, DIRVSingle ventricle, Mitral atresiaSingle ventricle, Tricuspid atresiaSingle ventricle, Unbalanced AV canalSingle ventricle, Heterotaxia syndromeSingle ventricle, OtherSingle ventricle + Total anomalous pulmonaryvenous connection (TAPVC)Congenitally corrected TGACongenitally corrected TGA, IVSCongenitally corrected TGA, IVS-LVOTOCongenitally corrected TGA, VSDCongenitally corrected TGA, VSD-LVOTOTGA, IVSTGA, IVS-LVOTOTGA, VSDTGA, VSD-LVOTODORV, VSD typeDORV, TOF typeDORV, TGA typeDORV, Remote VSD (uncommitted VSD)DORV + AVSD (AV Canal)DORV, IVSDOLVCoarctation of aortaAortic arch hypoplasiaVSD + Aortic arch hypoplasiaVSD + Coarctation of aortaCoronary artery anomaly, Anomalous aortic originof coronary artery (AAOCA)Coronary artery anomaly, Anomalous pulmonaryorigin (includes ALCAPA)Coronary artery anomaly, FistulaCoronary artery anomaly, AneurysmCoronary artery anomaly, Ostial atresiaCoronary artery anomaly, OtherInterrupted aortic archInterrupted aortic arch + VSDInterrupted aortic arch + AP window(aortopulmonary window)Patent ductus arteriosusVascular ringPulmonary artery sling
Aortic aneurysm (including pseudoaneurysm)Aortic dissectionLung disease, BenignLung disease, MalignantTracheal stenosisTracheomalaciaAirway diseasePleural disease, BenignPleural disease, MalignantPneumothoraxPleural effusionChylothoraxEmpyemaEsophageal disease, BenignEsophageal disease, MalignantMediastinal diseaseMediastinal disease, BenignMediastinal disease, MalignantDiaphragm paralysisDiaphragm disease, OtherRib tumor, BenignRib tumor, MalignantRib tumor, MetastaticSternal tumor, BenignSternal tumor, MalignantSternal tumor, MetastaticPectus carinatumPectus excavatumThoracic outlet syndromeArrhythmiaArrhythmia, Atrial, Atrial fibrillationArrhythmia, Atrial, Atrial flutterArrhythmia, Atrial, OtherArrhythmia, JunctionalArrhythmia, VentricularArrhythmia, Heart blockArrhythmia, Heart block, AcquiredArrhythmia, Heart block, CongenitalArrhythmia, Pacemaker, Indication for replacementAtrial Isomerism, LeftAtrial Isomerism, RightDextrocardiaLevocardiaMesocardiaSitus inversusAneurysm, Ventricular, Right (includingpseudoaneurysm)Aneurysm, Ventricular, Left (includingpseudoaneurysm)Aneurysm, Pulmonary arteryAneurysm, OtherHypoplastic RVHypoplastic LVPostoperative bleedingMediastinitisEndocarditisRheumatic heart diseaseProsthetic valve failureMyocardial infarctionCardiac tumorPulmonary AV fistulaPulmonary embolismPulmonary vascular obstructive diseasePulmonary vascular obstructive disease(Eisenmenger's)Primary pulmonary hypertensionPersistent fetal circulationMeconium aspirationKawasaki DiseaseCardiac, OtherThoracic and/or mediastinal, Other
Peripheral vascular, OtherComplication of cardiovascular catheterizationprocedureComplication of cardiovascular catheterizationprocedure, Device embolizationComplication of cardiovascular catheterizationprocedure, Device malfunctionComplication of cardiovascular catheterizationprocedure, PerforationComplication of interventional radiology procedureComplication of interventional radiologyprocedure, Device embolizationComplication of interventional radiologyprocedure, Device malfunctionComplication of interventional radiologyprocedure, PerforationForeign body, Intracardiac foreign bodyForeign body, Intravascular foreign bodyOpen sternum with closed skinOpen sternum with open skin (includes membraneplaced to close skin)Retained sternal wire causing irritationSyncopeTrauma, BluntTrauma, PenetratingNormal heartMiscellaneous, Other
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 29 of 140
Secondary diagnosis 6 NonePFOASD, SecundumASD, Sinus venosusASD, Coronary sinusASD, Common atrium (single atrium)ASD, Postoperative interatrial communicationVSD, Type 1 (Subarterial) (Supracristal) (Conalseptal defect) (Infundibular)VSD, Type 2 (Perimembranous) (Paramembranous)(Conoventricular)VSD, Type 3 (Inlet) (AV canal type)VSD, Type 4 (Muscular)VSD, Type: Gerbode type (LV-RA communication)VSD, MultipleAVC (AVSD), Complete (CAVSD)AVC (AVSD), Intermediate (transitional)AVC (AVSD), Partial (incomplete) (PAVSD) (ASD,primum)AP window (aortopulmonary window)Pulmonary artery origin from ascending aorta(hemitruncus)Truncus arteriosusTruncal valve insufficiencyTruncal valve stenosisTruncus arteriosus + Interrupted aortic archPartial anomalous pulmonary venous connection(PAPVC)Partial anomalous pulmonary venous connection(PAPVC), scimitarTotal anomalous pulmonary venous connection(TAPVC), Type1 (supracardiac)Total anomalous pulmonary venous connection(TAPVC), Type 2 (cardiac)Total anomalous pulmonary venous connection(TAPVC), Type 3 (infracardiac)Total anomalous pulmonary venous connection(TAPVC), Type 4 (mixed)Cor triatriatumPulmonary venous stenosisSystemic venous anomalySystemic venous obstructionTOFTOF, Pulmonary stenosisTOF, AVC (AVSD)TOF, Absent pulmonary valvePulmonary atresiaPulmonary atresia, IVSPulmonary atresia, VSD (Including TOF, PA)Pulmonary atresia, VSD-MAPCAMAPCA(s) (major aortopulmonary collateral[s])(without PA-VSD)Ebstein's anomalyTricuspid regurgitation, non-Ebstein's relatedTricuspid stenosisTricuspid regurgitation and tricuspid stenosisTricuspid valve, OtherPulmonary stenosis, ValvarPulmonary artery stenosis (hypoplasia), Main(trunk)Pulmonary artery stenosis, Branch, Central (withinthe hilar bifurcation)Pulmonary artery stenosis, Branch, Peripheral (ator beyond the hilar bifurcation)Pulmonary artery, DiscontinuousPulmonary stenosis, SubvalvarDCRVPulmonary valve, OtherPulmonary insufficiencyPulmonary insufficiency and pulmonary stenosis
Shunt FailureConduit failureAortic stenosis, SubvalvarAortic stenosis, ValvarAortic stenosis, SupravalvarAortic valve atresiaAortic insufficiencyAortic insufficiency and aortic stenosisAortic valve, OtherSinus of Valsalva aneurysmLV to aorta tunnelMitral stenosis, Supravalvar mitral ringMitral stenosis, ValvarMitral stenosis, SubvalvarMitral stenosis, Subvalvar, ParachuteMitral stenosisMitral regurgitation and mitral stenosisMitral regurgitationMitral valve, OtherHypoplastic left heart syndrome (HLHS)Shone's syndromeCardiomyopathy (including dilated, restrictive,and hypertrophic)Cardiomyopathy, End-stage congenital heart diseasePericardial effusionPericarditisPericardial disease, OtherSingle ventricle, DILVSingle ventricle, DIRVSingle ventricle, Mitral atresiaSingle ventricle, Tricuspid atresiaSingle ventricle, Unbalanced AV canalSingle ventricle, Heterotaxia syndromeSingle ventricle, OtherSingle ventricle + Total anomalous pulmonaryvenous connection (TAPVC)Congenitally corrected TGACongenitally corrected TGA, IVSCongenitally corrected TGA, IVS-LVOTOCongenitally corrected TGA, VSDCongenitally corrected TGA, VSD-LVOTOTGA, IVSTGA, IVS-LVOTOTGA, VSDTGA, VSD-LVOTODORV, VSD typeDORV, TOF typeDORV, TGA typeDORV, Remote VSD (uncommitted VSD)DORV + AVSD (AV Canal)DORV, IVSDOLVCoarctation of aortaAortic arch hypoplasiaVSD + Aortic arch hypoplasiaVSD + Coarctation of aortaCoronary artery anomaly, Anomalous aortic originof coronary artery (AAOCA)Coronary artery anomaly, Anomalous pulmonaryorigin (includes ALCAPA)Coronary artery anomaly, FistulaCoronary artery anomaly, AneurysmCoronary artery anomaly, Ostial atresiaCoronary artery anomaly, OtherInterrupted aortic archInterrupted aortic arch + VSDInterrupted aortic arch + AP window(aortopulmonary window)Patent ductus arteriosusVascular ringPulmonary artery sling
Aortic aneurysm (including pseudoaneurysm)Aortic dissectionLung disease, BenignLung disease, MalignantTracheal stenosisTracheomalaciaAirway diseasePleural disease, BenignPleural disease, MalignantPneumothoraxPleural effusionChylothoraxEmpyemaEsophageal disease, BenignEsophageal disease, MalignantMediastinal diseaseMediastinal disease, BenignMediastinal disease, MalignantDiaphragm paralysisDiaphragm disease, OtherRib tumor, BenignRib tumor, MalignantRib tumor, MetastaticSternal tumor, BenignSternal tumor, MalignantSternal tumor, MetastaticPectus carinatumPectus excavatumThoracic outlet syndromeArrhythmiaArrhythmia, Atrial, Atrial fibrillationArrhythmia, Atrial, Atrial flutterArrhythmia, Atrial, OtherArrhythmia, JunctionalArrhythmia, VentricularArrhythmia, Heart blockArrhythmia, Heart block, AcquiredArrhythmia, Heart block, CongenitalArrhythmia, Pacemaker, Indication for replacementAtrial Isomerism, LeftAtrial Isomerism, RightDextrocardiaLevocardiaMesocardiaSitus inversusAneurysm, Ventricular, Right (includingpseudoaneurysm)Aneurysm, Ventricular, Left (includingpseudoaneurysm)Aneurysm, Pulmonary arteryAneurysm, OtherHypoplastic RVHypoplastic LVPostoperative bleedingMediastinitisEndocarditisRheumatic heart diseaseProsthetic valve failureMyocardial infarctionCardiac tumorPulmonary AV fistulaPulmonary embolismPulmonary vascular obstructive diseasePulmonary vascular obstructive disease(Eisenmenger's)Primary pulmonary hypertensionPersistent fetal circulationMeconium aspirationKawasaki DiseaseCardiac, OtherThoracic and/or mediastinal, Other
Peripheral vascular, OtherComplication of cardiovascular catheterizationprocedureComplication of cardiovascular catheterizationprocedure, Device embolizationComplication of cardiovascular catheterizationprocedure, Device malfunctionComplication of cardiovascular catheterizationprocedure, PerforationComplication of interventional radiology procedureComplication of interventional radiologyprocedure, Device embolizationComplication of interventional radiologyprocedure, Device malfunctionComplication of interventional radiologyprocedure, PerforationForeign body, Intracardiac foreign bodyForeign body, Intravascular foreign bodyOpen sternum with closed skinOpen sternum with open skin (includes membraneplaced to close skin)Retained sternal wire causing irritationSyncopeTrauma, BluntTrauma, PenetratingNormal heartMiscellaneous, Other
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 33 of 140
Secondary diagnosis 7 NonePFOASD, SecundumASD, Sinus venosusASD, Coronary sinusASD, Common atrium (single atrium)ASD, Postoperative interatrial communicationVSD, Type 1 (Subarterial) (Supracristal) (Conalseptal defect) (Infundibular)VSD, Type 2 (Perimembranous) (Paramembranous)(Conoventricular)VSD, Type 3 (Inlet) (AV canal type)VSD, Type 4 (Muscular)VSD, Type: Gerbode type (LV-RA communication)VSD, MultipleAVC (AVSD), Complete (CAVSD)AVC (AVSD), Intermediate (transitional)AVC (AVSD), Partial (incomplete) (PAVSD) (ASD,primum)AP window (aortopulmonary window)Pulmonary artery origin from ascending aorta(hemitruncus)Truncus arteriosusTruncal valve insufficiencyTruncal valve stenosisTruncus arteriosus + Interrupted aortic archPartial anomalous pulmonary venous connection(PAPVC)Partial anomalous pulmonary venous connection(PAPVC), scimitarTotal anomalous pulmonary venous connection(TAPVC), Type1 (supracardiac)Total anomalous pulmonary venous connection(TAPVC), Type 2 (cardiac)Total anomalous pulmonary venous connection(TAPVC), Type 3 (infracardiac)Total anomalous pulmonary venous connection(TAPVC), Type 4 (mixed)Cor triatriatumPulmonary venous stenosisSystemic venous anomalySystemic venous obstructionTOFTOF, Pulmonary stenosisTOF, AVC (AVSD)TOF, Absent pulmonary valvePulmonary atresiaPulmonary atresia, IVSPulmonary atresia, VSD (Including TOF, PA)Pulmonary atresia, VSD-MAPCAMAPCA(s) (major aortopulmonary collateral[s])(without PA-VSD)Ebstein's anomalyTricuspid regurgitation, non-Ebstein's relatedTricuspid stenosisTricuspid regurgitation and tricuspid stenosisTricuspid valve, OtherPulmonary stenosis, ValvarPulmonary artery stenosis (hypoplasia), Main(trunk)Pulmonary artery stenosis, Branch, Central (withinthe hilar bifurcation)Pulmonary artery stenosis, Branch, Peripheral (ator beyond the hilar bifurcation)Pulmonary artery, DiscontinuousPulmonary stenosis, SubvalvarDCRVPulmonary valve, OtherPulmonary insufficiencyPulmonary insufficiency and pulmonary stenosis
Shunt FailureConduit failureAortic stenosis, SubvalvarAortic stenosis, ValvarAortic stenosis, SupravalvarAortic valve atresiaAortic insufficiencyAortic insufficiency and aortic stenosisAortic valve, OtherSinus of Valsalva aneurysmLV to aorta tunnelMitral stenosis, Supravalvar mitral ringMitral stenosis, ValvarMitral stenosis, SubvalvarMitral stenosis, Subvalvar, ParachuteMitral stenosisMitral regurgitation and mitral stenosisMitral regurgitationMitral valve, OtherHypoplastic left heart syndrome (HLHS)Shone's syndromeCardiomyopathy (including dilated, restrictive,and hypertrophic)Cardiomyopathy, End-stage congenital heart diseasePericardial effusionPericarditisPericardial disease, OtherSingle ventricle, DILVSingle ventricle, DIRVSingle ventricle, Mitral atresiaSingle ventricle, Tricuspid atresiaSingle ventricle, Unbalanced AV canalSingle ventricle, Heterotaxia syndromeSingle ventricle, OtherSingle ventricle + Total anomalous pulmonaryvenous connection (TAPVC)Congenitally corrected TGACongenitally corrected TGA, IVSCongenitally corrected TGA, IVS-LVOTOCongenitally corrected TGA, VSDCongenitally corrected TGA, VSD-LVOTOTGA, IVSTGA, IVS-LVOTOTGA, VSDTGA, VSD-LVOTODORV, VSD typeDORV, TOF typeDORV, TGA typeDORV, Remote VSD (uncommitted VSD)DORV + AVSD (AV Canal)DORV, IVSDOLVCoarctation of aortaAortic arch hypoplasiaVSD + Aortic arch hypoplasiaVSD + Coarctation of aortaCoronary artery anomaly, Anomalous aortic originof coronary artery (AAOCA)Coronary artery anomaly, Anomalous pulmonaryorigin (includes ALCAPA)Coronary artery anomaly, FistulaCoronary artery anomaly, AneurysmCoronary artery anomaly, Ostial atresiaCoronary artery anomaly, OtherInterrupted aortic archInterrupted aortic arch + VSDInterrupted aortic arch + AP window(aortopulmonary window)Patent ductus arteriosusVascular ringPulmonary artery sling
Aortic aneurysm (including pseudoaneurysm)Aortic dissectionLung disease, BenignLung disease, MalignantTracheal stenosisTracheomalaciaAirway diseasePleural disease, BenignPleural disease, MalignantPneumothoraxPleural effusionChylothoraxEmpyemaEsophageal disease, BenignEsophageal disease, MalignantMediastinal diseaseMediastinal disease, BenignMediastinal disease, MalignantDiaphragm paralysisDiaphragm disease, OtherRib tumor, BenignRib tumor, MalignantRib tumor, MetastaticSternal tumor, BenignSternal tumor, MalignantSternal tumor, MetastaticPectus carinatumPectus excavatumThoracic outlet syndromeArrhythmiaArrhythmia, Atrial, Atrial fibrillationArrhythmia, Atrial, Atrial flutterArrhythmia, Atrial, OtherArrhythmia, JunctionalArrhythmia, VentricularArrhythmia, Heart blockArrhythmia, Heart block, AcquiredArrhythmia, Heart block, CongenitalArrhythmia, Pacemaker, Indication for replacementAtrial Isomerism, LeftAtrial Isomerism, RightDextrocardiaLevocardiaMesocardiaSitus inversusAneurysm, Ventricular, Right (includingpseudoaneurysm)Aneurysm, Ventricular, Left (includingpseudoaneurysm)Aneurysm, Pulmonary arteryAneurysm, OtherHypoplastic RVHypoplastic LVPostoperative bleedingMediastinitisEndocarditisRheumatic heart diseaseProsthetic valve failureMyocardial infarctionCardiac tumorPulmonary AV fistulaPulmonary embolismPulmonary vascular obstructive diseasePulmonary vascular obstructive disease(Eisenmenger's)Primary pulmonary hypertensionPersistent fetal circulationMeconium aspirationKawasaki DiseaseCardiac, OtherThoracic and/or mediastinal, Other
Peripheral vascular, OtherComplication of cardiovascular catheterizationprocedureComplication of cardiovascular catheterizationprocedure, Device embolizationComplication of cardiovascular catheterizationprocedure, Device malfunctionComplication of cardiovascular catheterizationprocedure, PerforationComplication of interventional radiology procedureComplication of interventional radiologyprocedure, Device embolizationComplication of interventional radiologyprocedure, Device malfunctionComplication of interventional radiologyprocedure, PerforationForeign body, Intracardiac foreign bodyForeign body, Intravascular foreign bodyOpen sternum with closed skinOpen sternum with open skin (includes membraneplaced to close skin)Retained sternal wire causing irritationSyncopeTrauma, BluntTrauma, PenetratingNormal heartMiscellaneous, Other
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 37 of 140
Secondary diagnosis 8 NonePFOASD, SecundumASD, Sinus venosusASD, Coronary sinusASD, Common atrium (single atrium)ASD, Postoperative interatrial communicationVSD, Type 1 (Subarterial) (Supracristal) (Conalseptal defect) (Infundibular)VSD, Type 2 (Perimembranous) (Paramembranous)(Conoventricular)VSD, Type 3 (Inlet) (AV canal type)VSD, Type 4 (Muscular)VSD, Type: Gerbode type (LV-RA communication)VSD, MultipleAVC (AVSD), Complete (CAVSD)AVC (AVSD), Intermediate (transitional)AVC (AVSD), Partial (incomplete) (PAVSD) (ASD,primum)AP window (aortopulmonary window)Pulmonary artery origin from ascending aorta(hemitruncus)Truncus arteriosusTruncal valve insufficiencyTruncal valve stenosisTruncus arteriosus + Interrupted aortic archPartial anomalous pulmonary venous connection(PAPVC)Partial anomalous pulmonary venous connection(PAPVC), scimitarTotal anomalous pulmonary venous connection(TAPVC), Type1 (supracardiac)Total anomalous pulmonary venous connection(TAPVC), Type 2 (cardiac)Total anomalous pulmonary venous connection(TAPVC), Type 3 (infracardiac)Total anomalous pulmonary venous connection(TAPVC), Type 4 (mixed)Cor triatriatumPulmonary venous stenosisSystemic venous anomalySystemic venous obstructionTOFTOF, Pulmonary stenosisTOF, AVC (AVSD)TOF, Absent pulmonary valvePulmonary atresiaPulmonary atresia, IVSPulmonary atresia, VSD (Including TOF, PA)Pulmonary atresia, VSD-MAPCAMAPCA(s) (major aortopulmonary collateral[s])(without PA-VSD)Ebstein's anomalyTricuspid regurgitation, non-Ebstein's relatedTricuspid stenosisTricuspid regurgitation and tricuspid stenosisTricuspid valve, OtherPulmonary stenosis, ValvarPulmonary artery stenosis (hypoplasia), Main(trunk)Pulmonary artery stenosis, Branch, Central (withinthe hilar bifurcation)Pulmonary artery stenosis, Branch, Peripheral (ator beyond the hilar bifurcation)Pulmonary artery, DiscontinuousPulmonary stenosis, SubvalvarDCRVPulmonary valve, OtherPulmonary insufficiencyPulmonary insufficiency and pulmonary stenosis
Shunt FailureConduit failureAortic stenosis, SubvalvarAortic stenosis, ValvarAortic stenosis, SupravalvarAortic valve atresiaAortic insufficiencyAortic insufficiency and aortic stenosisAortic valve, OtherSinus of Valsalva aneurysmLV to aorta tunnelMitral stenosis, Supravalvar mitral ringMitral stenosis, ValvarMitral stenosis, SubvalvarMitral stenosis, Subvalvar, ParachuteMitral stenosisMitral regurgitation and mitral stenosisMitral regurgitationMitral valve, OtherHypoplastic left heart syndrome (HLHS)Shone's syndromeCardiomyopathy (including dilated, restrictive,and hypertrophic)Cardiomyopathy, End-stage congenital heart diseasePericardial effusionPericarditisPericardial disease, OtherSingle ventricle, DILVSingle ventricle, DIRVSingle ventricle, Mitral atresiaSingle ventricle, Tricuspid atresiaSingle ventricle, Unbalanced AV canalSingle ventricle, Heterotaxia syndromeSingle ventricle, OtherSingle ventricle + Total anomalous pulmonaryvenous connection (TAPVC)Congenitally corrected TGACongenitally corrected TGA, IVSCongenitally corrected TGA, IVS-LVOTOCongenitally corrected TGA, VSDCongenitally corrected TGA, VSD-LVOTOTGA, IVSTGA, IVS-LVOTOTGA, VSDTGA, VSD-LVOTODORV, VSD typeDORV, TOF typeDORV, TGA typeDORV, Remote VSD (uncommitted VSD)DORV + AVSD (AV Canal)DORV, IVSDOLVCoarctation of aortaAortic arch hypoplasiaVSD + Aortic arch hypoplasiaVSD + Coarctation of aortaCoronary artery anomaly, Anomalous aortic originof coronary artery (AAOCA)Coronary artery anomaly, Anomalous pulmonaryorigin (includes ALCAPA)Coronary artery anomaly, FistulaCoronary artery anomaly, AneurysmCoronary artery anomaly, Ostial atresiaCoronary artery anomaly, OtherInterrupted aortic archInterrupted aortic arch + VSDInterrupted aortic arch + AP window(aortopulmonary window)Patent ductus arteriosusVascular ringPulmonary artery sling
Aortic aneurysm (including pseudoaneurysm)Aortic dissectionLung disease, BenignLung disease, MalignantTracheal stenosisTracheomalaciaAirway diseasePleural disease, BenignPleural disease, MalignantPneumothoraxPleural effusionChylothoraxEmpyemaEsophageal disease, BenignEsophageal disease, MalignantMediastinal diseaseMediastinal disease, BenignMediastinal disease, MalignantDiaphragm paralysisDiaphragm disease, OtherRib tumor, BenignRib tumor, MalignantRib tumor, MetastaticSternal tumor, BenignSternal tumor, MalignantSternal tumor, MetastaticPectus carinatumPectus excavatumThoracic outlet syndromeArrhythmiaArrhythmia, Atrial, Atrial fibrillationArrhythmia, Atrial, Atrial flutterArrhythmia, Atrial, OtherArrhythmia, JunctionalArrhythmia, VentricularArrhythmia, Heart blockArrhythmia, Heart block, AcquiredArrhythmia, Heart block, CongenitalArrhythmia, Pacemaker, Indication for replacementAtrial Isomerism, LeftAtrial Isomerism, RightDextrocardiaLevocardiaMesocardiaSitus inversusAneurysm, Ventricular, Right (includingpseudoaneurysm)Aneurysm, Ventricular, Left (includingpseudoaneurysm)Aneurysm, Pulmonary arteryAneurysm, OtherHypoplastic RVHypoplastic LVPostoperative bleedingMediastinitisEndocarditisRheumatic heart diseaseProsthetic valve failureMyocardial infarctionCardiac tumorPulmonary AV fistulaPulmonary embolismPulmonary vascular obstructive diseasePulmonary vascular obstructive disease(Eisenmenger's)Primary pulmonary hypertensionPersistent fetal circulationMeconium aspirationKawasaki DiseaseCardiac, OtherThoracic and/or mediastinal, Other
Peripheral vascular, OtherComplication of cardiovascular catheterizationprocedureComplication of cardiovascular catheterizationprocedure, Device embolizationComplication of cardiovascular catheterizationprocedure, Device malfunctionComplication of cardiovascular catheterizationprocedure, PerforationComplication of interventional radiology procedureComplication of interventional radiologyprocedure, Device embolizationComplication of interventional radiologyprocedure, Device malfunctionComplication of interventional radiologyprocedure, PerforationForeign body, Intracardiac foreign bodyForeign body, Intravascular foreign bodyOpen sternum with closed skinOpen sternum with open skin (includes membraneplaced to close skin)Retained sternal wire causing irritationSyncopeTrauma, BluntTrauma, PenetratingNormal heartMiscellaneous, Other
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 41 of 140
Secondary diagnosis 9 NonePFOASD, SecundumASD, Sinus venosusASD, Coronary sinusASD, Common atrium (single atrium)ASD, Postoperative interatrial communicationVSD, Type 1 (Subarterial) (Supracristal) (Conalseptal defect) (Infundibular)VSD, Type 2 (Perimembranous) (Paramembranous)(Conoventricular)VSD, Type 3 (Inlet) (AV canal type)VSD, Type 4 (Muscular)VSD, Type: Gerbode type (LV-RA communication)VSD, MultipleAVC (AVSD), Complete (CAVSD)AVC (AVSD), Intermediate (transitional)AVC (AVSD), Partial (incomplete) (PAVSD) (ASD,primum)AP window (aortopulmonary window)Pulmonary artery origin from ascending aorta(hemitruncus)Truncus arteriosusTruncal valve insufficiencyTruncal valve stenosisTruncus arteriosus + Interrupted aortic archPartial anomalous pulmonary venous connection(PAPVC)Partial anomalous pulmonary venous connection(PAPVC), scimitarTotal anomalous pulmonary venous connection(TAPVC), Type1 (supracardiac)Total anomalous pulmonary venous connection(TAPVC), Type 2 (cardiac)Total anomalous pulmonary venous connection(TAPVC), Type 3 (infracardiac)Total anomalous pulmonary venous connection(TAPVC), Type 4 (mixed)Cor triatriatumPulmonary venous stenosisSystemic venous anomalySystemic venous obstructionTOFTOF, Pulmonary stenosisTOF, AVC (AVSD)TOF, Absent pulmonary valvePulmonary atresiaPulmonary atresia, IVSPulmonary atresia, VSD (Including TOF, PA)Pulmonary atresia, VSD-MAPCAMAPCA(s) (major aortopulmonary collateral[s])(without PA-VSD)Ebstein's anomalyTricuspid regurgitation, non-Ebstein's relatedTricuspid stenosisTricuspid regurgitation and tricuspid stenosisTricuspid valve, OtherPulmonary stenosis, ValvarPulmonary artery stenosis (hypoplasia), Main(trunk)Pulmonary artery stenosis, Branch, Central (withinthe hilar bifurcation)Pulmonary artery stenosis, Branch, Peripheral (ator beyond the hilar bifurcation)Pulmonary artery, DiscontinuousPulmonary stenosis, SubvalvarDCRVPulmonary valve, OtherPulmonary insufficiencyPulmonary insufficiency and pulmonary stenosis
Shunt FailureConduit failureAortic stenosis, SubvalvarAortic stenosis, ValvarAortic stenosis, SupravalvarAortic valve atresiaAortic insufficiencyAortic insufficiency and aortic stenosisAortic valve, OtherSinus of Valsalva aneurysmLV to aorta tunnelMitral stenosis, Supravalvar mitral ringMitral stenosis, ValvarMitral stenosis, SubvalvarMitral stenosis, Subvalvar, ParachuteMitral stenosisMitral regurgitation and mitral stenosisMitral regurgitationMitral valve, OtherHypoplastic left heart syndrome (HLHS)Shone's syndromeCardiomyopathy (including dilated, restrictive,and hypertrophic)Cardiomyopathy, End-stage congenital heart diseasePericardial effusionPericarditisPericardial disease, OtherSingle ventricle, DILVSingle ventricle, DIRVSingle ventricle, Mitral atresiaSingle ventricle, Tricuspid atresiaSingle ventricle, Unbalanced AV canalSingle ventricle, Heterotaxia syndromeSingle ventricle, OtherSingle ventricle + Total anomalous pulmonaryvenous connection (TAPVC)Congenitally corrected TGACongenitally corrected TGA, IVSCongenitally corrected TGA, IVS-LVOTOCongenitally corrected TGA, VSDCongenitally corrected TGA, VSD-LVOTOTGA, IVSTGA, IVS-LVOTOTGA, VSDTGA, VSD-LVOTODORV, VSD typeDORV, TOF typeDORV, TGA typeDORV, Remote VSD (uncommitted VSD)DORV + AVSD (AV Canal)DORV, IVSDOLVCoarctation of aortaAortic arch hypoplasiaVSD + Aortic arch hypoplasiaVSD + Coarctation of aortaCoronary artery anomaly, Anomalous aortic originof coronary artery (AAOCA)Coronary artery anomaly, Anomalous pulmonaryorigin (includes ALCAPA)Coronary artery anomaly, FistulaCoronary artery anomaly, AneurysmCoronary artery anomaly, Ostial atresiaCoronary artery anomaly, OtherInterrupted aortic archInterrupted aortic arch + VSDInterrupted aortic arch + AP window(aortopulmonary window)Patent ductus arteriosusVascular ringPulmonary artery sling
Aortic aneurysm (including pseudoaneurysm)Aortic dissectionLung disease, BenignLung disease, MalignantTracheal stenosisTracheomalaciaAirway diseasePleural disease, BenignPleural disease, MalignantPneumothoraxPleural effusionChylothoraxEmpyemaEsophageal disease, BenignEsophageal disease, MalignantMediastinal diseaseMediastinal disease, BenignMediastinal disease, MalignantDiaphragm paralysisDiaphragm disease, OtherRib tumor, BenignRib tumor, MalignantRib tumor, MetastaticSternal tumor, BenignSternal tumor, MalignantSternal tumor, MetastaticPectus carinatumPectus excavatumThoracic outlet syndromeArrhythmiaArrhythmia, Atrial, Atrial fibrillationArrhythmia, Atrial, Atrial flutterArrhythmia, Atrial, OtherArrhythmia, JunctionalArrhythmia, VentricularArrhythmia, Heart blockArrhythmia, Heart block, AcquiredArrhythmia, Heart block, CongenitalArrhythmia, Pacemaker, Indication for replacementAtrial Isomerism, LeftAtrial Isomerism, RightDextrocardiaLevocardiaMesocardiaSitus inversusAneurysm, Ventricular, Right (includingpseudoaneurysm)Aneurysm, Ventricular, Left (includingpseudoaneurysm)Aneurysm, Pulmonary arteryAneurysm, OtherHypoplastic RVHypoplastic LVPostoperative bleedingMediastinitisEndocarditisRheumatic heart diseaseProsthetic valve failureMyocardial infarctionCardiac tumorPulmonary AV fistulaPulmonary embolismPulmonary vascular obstructive diseasePulmonary vascular obstructive disease(Eisenmenger's)Primary pulmonary hypertensionPersistent fetal circulationMeconium aspirationKawasaki DiseaseCardiac, OtherThoracic and/or mediastinal, Other
Peripheral vascular, OtherComplication of cardiovascular catheterizationprocedureComplication of cardiovascular catheterizationprocedure, Device embolizationComplication of cardiovascular catheterizationprocedure, Device malfunctionComplication of cardiovascular catheterizationprocedure, PerforationComplication of interventional radiology procedureComplication of interventional radiologyprocedure, Device embolizationComplication of interventional radiologyprocedure, Device malfunctionComplication of interventional radiologyprocedure, PerforationForeign body, Intracardiac foreign bodyForeign body, Intravascular foreign bodyOpen sternum with closed skinOpen sternum with open skin (includes membraneplaced to close skin)Retained sternal wire causing irritationSyncopeTrauma, BluntTrauma, PenetratingNormal heartMiscellaneous, Other
Notes on diagnosis __________________________________________
Pulmonary vein connections TAPVDPAPVDNormal anatomical connections
TAPVD type specified SupracardiacCardiacInfracardiacMixed typeOther
TAPVD specified Obstructed- Vertical VeinSmall or obstructed pulmonary vein confluenceNot obstructedUnknown
SECTION: PULMONARY VEIN CONNECTIONS AT FIRST PRESENTATION/DIAGNOSIS OF PVS
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 45 of 140
Pulmonary vein anatomy Right common(check all that apply) Right upper
Right middleRight lowerLeft commonLeft upperLeft lingulaLeft lower
Pulmonary vein connection to right atrium YesNo
Pulmonary vein connections to right atrium RUPV(check all that apply) RMPV
RLPVRCPVLUPVLLPVLCPV
Pulmonary vein connection to left atrium YesNo
Pulmonary vein connections to left atrium RUPV(check all that apply) RMPV
RLPVRCPVLUPVLLPVLCPV
Pulmonary vein connection to systemic venous system YesNo
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 46 of 140
Pulmonary vein connections to systemic venous system RUPV(check all that apply) RMPV
RLPVRCPVLUPVLLPVLCPV
Comment on pulmonary vein anatomy and connections attime of first presentation/ diagnosis of PVS
__________________________________________
Modalities used to diagnosis/ at first presentation Echocardiography(check all that apply) MRI
CT scanHeart catheterizationLung perfusion scan
(Specific modality data to be entered in thefollow-up database)
Comments on specific cardiac diagnosis __________________________________________
SECTION: OTHER CLINICAL COMORBIDITIES
Diagnosis of GERD YesNoUnknown
Treatment of GERD No treatmentMedicalNissenG/J tubeUnknown
Diagnosis of bronchopulmonary dysplasia YesNoUnknown
Evidence of pulmonary lymphangectasia Yes, suspected diagnosis (imaging suggestive)Yes, confirmed diagnosisNoUnknown
Comments on demographics and clinical __________________________________________
06/04/2017 10:33am www.projectredcap.org
ConfidentialPVS registry
Page 47 of 140
Genetics and family history
GENETICS AND FAMILY HISTORY
SECTION: GENETICS
Diagnosis confirmation Yes, confirmedSuspected or being investigatedNoUnknown
Genetic diagnosis VACTERL associationCHARGETrisomy 21Adams-Oliver SyndromeOther
Other confirmed genetic diagnosis __________________________________
Other suspected or investigated genetic diagnosis __________________________________
Specific syndrome components describedie. limb defects; developmental delay
__________________________________________
SECTION: FAMILY HISTORY: PARENTS AND SIBLINGS
Consanguinity in parents of affected child YesNoUnknown
MOTHER
Yes No UnknownCongenital heart disease (excluding pulmonary veins)
Pulmonary vein stenosisAbnormally connected PV(TAPVD/PAPVD)
Confirmed genetic syndrome(any)
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 48 of 140
FATHER
Yes No UnknownCongenital heart disease (excluding pulmonary veins)
Pulmonary vein stenosisAbnormally connected PV(TAPVD/PAPVD)
Confirmed genetic syndrome(any)
BROTHER
Yes No UnknownCongenital heart disease (excluding pulmonary veins)
Pulmonary vein stenosisAbnormally connected PV(TAPVD/PAPVD)
Confirmed genetic syndrome(any)
SISTER
Yes No UnknownCongenital heart disease (excluding pulmonary veins)
Pulmonary vein stenosisAbnormally connected PV(TAPVD/PAPVD)
Confirmed genetic syndrome(any)
Comments on family history (parents and siblings) __________________________________________
SECTION: FAMILY HISTORY: MATERNAL GRANDPARENTS
Consanguinity in maternal grandparents YesNoUnknown
Remote consanguinity in maternal side YesNoUnknown
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 49 of 140
MATERNAL GRANDMOTHER
Yes No UnknownCongenital heart disease (excluding pulmonary veins)
Pulmonary vein stenosisAbnormally connected PV(TAPVD/PAPVD)
Confirmed genetic syndrome(any)
MATERNAL GRANDFATHER
Yes No UnknownCongenital heart disease (excluding pulmonary veins)
Pulmonary vein stenosisAbnormally connected PV(TAPVD/PAPVD)
Confirmed genetic syndrome(any)
MATERNAL SIBLINGS
Yes No UnknownCongenital heart disease (excluding pulmonary veins)
Pulmonary vein stenosisAbnormally connected PV(TAPVD/PAPVD)
Confirmed genetic syndrome(any)
Comments on family history (maternalgrandparents/siblings)
__________________________________________
SECTION: FAMILY HISTORY: PATERNAL GRANDPARENTS
Consanguinity in paternal grandparents YesNoUnknown
Remote consanguinity in paternal side YesNoUnknown
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 50 of 140
PATERNAL GRANDMOTHER
Yes No UnknownCongenital heart disease (excluding pulmonary veins)
Pulmonary vein stenosisAbnormally connected PV(TAPVD/PAPVD)
Confirmed genetic syndrome(any)
PATERNAL GRANDFATHER
Yes No UnknownCongenital heart disease (excluding pulmonary veins)
Pulmonary vein stenosisAbnormally connected PV(TAPVD/PAPVD)
Confirmed genetic syndrome(any)
PATERNAL SIBLINGS
Yes No UnknownCongenital heart disease (excluding pulmonary veins)
Pulmonary vein stenosisAbnormally connected PV(TAPVD/PAPVD)
Confirmed genetic syndrome(any)
Comments on family history (paternalgrandparents/siblings)
__________________________________________
Upload pedigree (deidentified)
Comments on genetics and family history __________________________________________
06/04/2017 10:33am www.projectredcap.org
ConfidentialPVS registry
Page 51 of 140
Medications
MEDICATIONS
SECTION: EXPERIMENTAL THERAPY
Use of experimental therapies for PVS YesNo
Imatinib (e.g., Gleevec) Yes No
Imatinib: start date __________________________________
Imatinib: end date __________________________________
Imatinib: highest dose (mg/m2/day) __________________________________(Please enter dose per m2of body surface area perday)
Bevacizumab (e.g., Avastin) Yes No
Bevacizumab: start date __________________________________
Bevacizumab: end date __________________________________
Bevacizumab: highest dose (mg/kg/week) __________________________________(Please enter dose per kg per week)
Losartan Yes No
Losartan: start date __________________________________
Losartan: end date __________________________________
Losrtan: highest dose (mg/kg/day) __________________________________(Please enter dose per kg per day)
Any other experimental therapy for PVS Yes No
Specify the other experimental therapy __________________________________
[expmedothtx]: start date __________________________________
[expmedothtx]: end date __________________________________
[expmedothtx]: highest dose __________________________________
[expmedothtx]: highest dose (unit) __________________________________(Please specify the unit of the dose)
Comments on experimental therapy __________________________________________
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 52 of 140
SECTION: PULMONARY HYPERTENSION MEDICATIONS
Pulmonary hypertension medications YesNo
Nitric oxide Yes No
Nitric oxide: start date (if known) __________________________________
Nitric oxide: end date (if known) __________________________________
Nitric oxide: highest dose (ppm) (if known) __________________________________(Please enter dose in ppm)
Sildenafil Yes No
Sildenfil: start date (if known) __________________________________
Sildenfil: end date (if known) __________________________________
Sildenfil: highest dose (mg/kg) (if known) __________________________________(Please enter dose per kg per day)
Tadalafil Yes No
Tadalfil: start date (if known) __________________________________
Tadalfil: end date (if known) __________________________________
Tadalfil: highest dose (mg/kg) (if known) __________________________________(Please enter dose per kg per day)
Bosentan Yes No
Bosentan: start date (if known) __________________________________
Bosentan: end date (if known) __________________________________
Bosentan: highest dose (mg/kg) (if known) __________________________________(Please enter dose per kg per day)
Epoprostenol Yes No
Epoprostenol: start date (if known) __________________________________
Epoprostenol: end date (if known) __________________________________
Epoprostenol: highest dose (ng/kg/min) (if known) __________________________________(Please enter dose per kg per minute)
Nifedipine Yes No
Nifedipine: start date (if known) __________________________________
Nifedipine: end date (if known) __________________________________
Nifedipine: highest dose (mg/kg) (if known) __________________________________(Please enter dose per kg per day)
Other Yes No
Specify the other PHTN medication __________________________________
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 53 of 140
[phtnmedothtx]: start date __________________________________
[phtnmedothtx]: end date __________________________________
[phtnmedothtx]: highest dose __________________________________
[phtnmedothtx]: highest dose (unit) __________________________________(Please specify the unit of the dose)
Comments on PHTN medications __________________________________________
06/04/2017 10:33am www.projectredcap.org
ConfidentialPVS registry
Page 54 of 140
Hospitalization
HOSPITALIZATIONExclude hospitalization events for pulmonary vein surgery/intervention/cardiac surgery/lungtransplant
Was the hospitalization solely for any of the Yesreason(s): NoPV surgeryPV interventionCardiacprocedure/surgeryLung transplant
Please complete the relevant form(s).Hospitalization form is not required to fill out.
Date of hospitalization __________________________________
Age (years) __________________________________(e.g., for age 2 years and 9 months > put "2")
Age (months) __________________________________(e.g., for age 2 years and 11 months > put "11")
Age in years (calculated filed) __________________________________(e.g., for age 2 years & 11 months > this fielddisplays "2.92")
SECTION: HOSPITALIZATION DATA
Reason for hospitalization: infection YesNo
Date of infection __________________________________
Type of infection Pneumonia (radiographic or change in O2requirements)InfluenzaParainfluenza virusRespiratory syncytial virus (RSV)Necrotizing enterocolitisRhinovirusOther
Specify the other infection __________________________________
Reason for hospitalization: cardiorespiratory reason Yesreasons may include hospital admissions to treat Nocardiac symptoms e.g., heart failure or increasedwork of breathing
Specify the cardiac reason(s) for hospitalization __________________________________
Any other reason for hospitalization YesNo
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 55 of 140
Specify the other reason(s) for hospitalization __________________________________
Intubated during hospitalization YesNo
Total number for days intubated __________________________________
Highest level of oxygen support for those not Supplemental oxygen by nasal prongsrequiring intubation/ mechanical ventilation High flow nasal canula > 2LPM
Non invasive ventilator support (CPAP/BiPAP)
Inotropic support YesNo
Extracorporeal life support during hospitalization YesNo
Type of ECLS VV ECMOVA ECMONovalung/PLAD
Any non-cardiac procedure in hospital YesNo
Date of procedure during hospitalization __________________________________
Specify the non-cardiac procedure during __________________________________hospitalization
Date of discharge from hospital __________________________________
Duration of hospital stay (days) __________________________________
Comments on hospitalization __________________________________________
06/04/2017 10:33am www.projectredcap.org
ConfidentialPVS registry
Page 56 of 140
Cardiac procedures
CARDIAC PROCEDUREExclude cardiac procedures involving pulmonary veins
Does this cardiac procedure involve pulmonary Yesvein(s)? No
Please complete the PV surgery or cath. interventions form."Cardiac procedures" form is not required to fill out.
Cardiac procedure date __________________________________
Age (years) __________________________________(e.g., for age 2 years and 9 months > put "2")
Age (months) __________________________________(e.g., for age 2 years and 11 months > put "11")
Age in years (calculated filed) __________________________________(e.g., for age 2 years & 11 months > this fielddisplays "2.92")
SECTION: CARDIAC PROCEDURE SPECIFICATION
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 57 of 140
Specify the primary cardiac procedure PFO, Primary closureASD repair, Primary closureASD repair, PatchASD repair, DeviceASD repair, Patch + PAPVC repairASD, Common atrium (single atrium), SeptationASD creation/enlargementASD partial closureAtrial septal fenestrationAtrial fenestration closureVSD repair, Primary closureVSD repair, PatchVSD repair, DeviceVSD, Multiple, RepairVSD creation/enlargementVentricular septal fenestrationAVC (AVSD) repair, Complete (CAVSD)AVC (AVSD) repair, Intermediate (Transitional)AVC (AVSD) repair, Partial (Incomplete) (PAVSD)Valvuloplasty, Common atrioventricular valveValvuloplasty converted to valve replacement inthe same operation, Common atrioventricular valveValve replacement, Common atrioventricular valveAP window repairPulmonary artery origin from ascending aorta(hemitruncus) repairTruncus arteriosus repairValvuloplasty, Truncal valveValvuloplasty converted to valve replacement inthe same operation, Truncal valveValve replacement, Truncal valveTruncus + Interrupted aortic arch repair (IAA)repairPAPVC repairPAPVC, Scimitar, RepairPAPVC repair, Baffle redirection to left atriumwith systemic vein translocation (Warden) (SVCsewn to right atrial appendage)TAPVC repairTAPVC repair + Shunt - systemic-to-pulmonaryCor triatriatum repairPulmonary venous stenosis repairAtrial baffle procedure (non-Mustard, non-Senning)Anomalous systemic venous connection repairSystemic venous stenosis repairTOF repair, No VentriculotomyTOF repair, Ventriculotomy, Nontransanular patchTOF repair, Ventriculotomy, Transanular patchTOF repair, RV-PA conduitTOF - AVC (AVSD) repairTOF - Absent pulmonary valve repairPulmonary atresia - VSD (including TOF, PA) repairPulmonary atresia - VSD - MAPCA repair, Completesingle stage repair (1 stage that includesbilateral pulmonary unifocalization + VSD closure+ RV to PA connection [with or without conduit])Pulmonary atresia - VSD - MAPCA repair, Statuspost prior complete unifocalization (includes VSDclosure + RV to PA connection [with or withoutconduit])Pulmonary atresia - VSD - MAPCA repair, Statuspost prior incomplete unifocalization (includescompletion of pulmonary unifocalization + VSDclosure + RV to PA connection [with or withoutconduit])Unifocalization MAPCA(s), Bilateral pulmonaryunifocalization - Complete unifocalization (allusable MAPCA[s] are incorporated)Unifocalization MAPCA(s), Bilateral pulmonaryunifocalization - Incomplete unifocalization (not
all usable MAPCA[s] are incorporated)Unifocalization MAPCA(s), Unilateral pulmonaryunifocalizationUnifocalization MAPCA(s)Occlusion of MAPCA(s)Valvuloplasty, Tricuspid (do not use this code iftricuspid valve malfunction is secondary toEbstein's anomaly. Use 465Valvuloplasty converted to valve replacement inthe same operation, TricuspidEbstein's repairValve replacement, Tricuspid (TVR)Valve closure, Tricuspid (exclusion,univentricular approach)Valve excision, Tricuspid (without replacement)Valve surgery, Other, TricuspidRVOT procedure1 1/2 ventricular repairPA, reconstruction (plasty), Main (trunk)PA, reconstruction (plasty), Branch, Central(within the hilar bifurcation)PA, reconstruction (plasty), Branch, Peripheral(at or beyond the hilar bifurcation)DCRV repairValvuloplasty, PulmonicValvuloplasty converted to valve replacement inthe same operation, PulmonicValve replacement, Pulmonic (PVR)Valve excision, Pulmonary (without replacement)Valve closure, SemilunarValve surgery, Other, PulmonicConduit placement, RV to PAConduit placement, LV to PAConduit placement, Ventricle to aortaConduit placement, OtherConduit reoperationValvuloplasty, AorticValvuloplasty converted to valve replacement inthe same operation, AorticValvuloplasty converted to valve replacement inthe same operation, Aortic - with Ross procedureValvuloplasty converted to valve replacement inthe same operation, Aortic - with Ross-KonnoprocedureValve replacement, Aortic (AVR)Valve replacement, Aortic (AVR), MechanicalValve replacement, Aortic (AVR), BioprostheticValve replacement, Aortic (AVR), HomograftAortic root replacement, BioprostheticAortic root replacement, MechanicalAortic root replacement, HomograftAortic root replacement, Valve sparingRoss procedureKonno procedureRoss-Konno procedureOther annular enlargement procedureAortic stenosis, Subvalvar, RepairAortic stenosis, Subvalvar, Repair, With myectomyfor IHSSAortic stenosis, Supravalvar, RepairValve surgery, Other, AorticSinus of Valsalva, Aneurysm repairLV to aorta tunnel repairValvuloplasty, MitralValvuloplasty converted to valve replacement inthe same operation, MitralMitral stenosis, Supravalvar mitral ring repairValve replacement, Mitral (MVR)Valve surgery, Other, MitralNorwood procedureHLHS biventricular repair
Conduit insertion right ventricle to pulmonaryartery + Intraventricular tunnel left ventricle toneoaorta + arch reconstruction (Rastelli andNorwood type arch reconstruction) (Yasui)Hybrid Approach "Stage 1", Application of RPA &LPA bandsHybrid Approach "Stage 1", Stent placement inarterial duct (PDA)Hybrid Approach "Stage 1", Stent placement inarterial duct (PDA) + application of RPA & LPAbandsHybrid approach "Stage 2", Aortopulmonaryamalgamation + Superior Cavopulmonaryanastomosis(es) + PA Debanding + Aortic archrepair (Norwood [Stage 1] + Superior Cavopulmonaryanastomosis(es) + PA Debanding)Hybrid approach "Stage 2", Aortopulmonaryamalgamation + Superior Cavopulmonaryanastomosis(es) + PA Debanding + Without aorticarch repairHybrid Approach, Transcardiac balloon dilatationHybrid Approach, Transcardiac transcatheter deviceplacementTransplant, HeartTransplant, Heart and lungPartial left ventriculectomy (LV volume reductionsurgery) (Batista)Pericardial drainage procedurePericardiectomyPericardial procedure, OtherFontan, Atrio-pulmonary connectionFontan, Atrio-ventricular connectionFontan, TCPC, Lateral tunnel, FenestratedFontan, TCPC, Lateral tunnel, NonfenestratedFontan, TCPC, External conduit, FenestratedFontan, TCPC, External conduit, NonfenestratedFontan, TCPC, Intra/extracardiac conduit,FenestratedFontan, TCPC, Intra/extracardiac conduit,NonfenestratedFontan, TCPC, External conduit, hepatic veins topulmonary artery, FenestratedFontan, TCPC, External conduit, hepatic veins topulmonary artery, NonfenestratedFontan revision or conversion (Re-do Fontan)Fontan, OtherFontan + Atrioventricular valvuloplastyVentricular septationCongenitally corrected TGA repair, Atrial switchand ASO (double switch)Congenitally corrected TGA repair, Atrial switchand RastelliCongenitally corrected TGA repair, VSD closureCongenitally corrected TGA repair, VSD closure andLV to PA conduitCongenitally corrected TGA repair, OtherArterial switch operation (ASO)Arterial switch operation (ASO) and VSD repairArterial switch procedure + Aortic arch repairArterial switch procedure and VSD repair + Aorticarch repairSenningMustardAtrial baffle procedure, Mustard or SenningrevisionRastelliREVAortic root translocation over left ventricle(Including Nikaidoh procedure)TGA, Other procedures (Kawashima, LV-PA conduit,other)
DORV, Intraventricular tunnel repairDOLV repairCoarctation repair, End to endCoarctation repair, End to end, ExtendedCoarctation repair, Subclavian flapCoarctation repair, Patch aortoplastyCoarctation repair, Interposition graftCoarctation repair, OtherCoarctation repair + VSD repairAortic arch repairAortic arch repair + VSD repairCoronary artery fistula ligationAnomalous origin of coronary artery from pulmonaryartery repairCoronary artery bypassAnomalous aortic origin of coronary artery (AAOCA)repairCoronary artery procedure, OtherInterrupted aortic arch repairPDA closure, SurgicalPDA closure, DeviceVascular ring repairAortopexyPulmonary artery sling repairAortic aneurysm repairAortic dissection repairLung biopsyTransplant, lung(s)Lung procedure, OtherTracheal procedureMuscle flap, Trunk (i.e. intercostal, pectus, orserratus muscle)Muscle flap, Trunk (i.e. latissimus dorsi)Removal, Sternal wireRib excision, CompleteRib excision, PartialSternal fracture, Open treatmentSternal resection, Radical resection of the sternumSternal resection, Radical resection of thesternum with mediastinal lymphadenectomyTumor of chest wall, Excision including ribsTumor of chest wall, Excision including ribs, WithreconstructionTumor of soft tissue of thorax, Excision of deepsubfascial or intramuscular tumorTumor of soft tissue of thorax, Excision ofsubcutaneous tumorTumor of soft tissue of thorax, Radical resectionHyoid myotomy and suspensionMuscle flap, NeckProcedure on neckTumor of soft tissue of neck, Excision of deepsubfascial or intramuscular tumorTumor of soft tissue of neck, Excision ofsubcutaneous tumorTumor of soft tissue of neck, Radical resectionPectus bar removalPectus bar repositioningPectus repair, Minimally invasive repair (Nuss),With thoracoscopyPectus repair, Minimally invasive repair (Nuss),Without thoracoscopyPectus repair, Open repairDivision of scalenus anticus, With resection of acervical ribDivision of scalenus anticus, Without resection ofa cervical ribRib excision, Excision of a cervical ribRib excision, Excision of a cervical rib, WithsympathectomyRib excision, Excision of first rib
Rib excision, Excision of first rib, WithsympathectomyProcedure on thoraxPacemaker implantation, PermanentPacemaker procedureExplantation of pacing systemICD (AICD) implantationICD (AICD) ([automatic] implantable cardioverterdefibrillator) procedureArrhythmia surgery - atrial, Surgical AblationArrhythmia surgery - ventricular, Surgical AblationCardiovascular catheterization procedure,DiagnosticCardiovascular catheterization procedure,Diagnostic, Angiographic data obtainedCardiovascular catheterization procedure,Diagnostic, Electrophysiology alterationCardiovascular catheterization procedure,Diagnostic, Hemodynamic alterationCardiovascular catheterization procedure,Diagnostic, Hemodynamic data obtainedCardiovascular catheterization procedure,Diagnostic, Transluminal test occlusionCardiovascular catheterization procedure,TherapeuticCardiovascular catheterization procedure,Therapeutic, Adjunctive therapyCardiovascular catheterization procedure,Therapeutic, Balloon dilationCardiovascular catheterization procedure,Therapeutic, Balloon valvotomyCardiovascular catheterization procedure,Therapeutic, Coil implantationCardiovascular catheterization procedure,Therapeutic, Device implantationCardiovascular catheterization procedure,Therapeutic, Device implantation attemptedCardiovascular catheterization procedure,Therapeutic, Electrophysiological ablationCardiovascular catheterization procedure,Therapeutic, Intravascular foreign body removalCardiovascular catheterization procedure,Therapeutic, Perforation (establishinginterchamber and/or intervessel communication)Cardiovascular catheterization procedure,Therapeutic, SeptostomyCardiovascular catheterization procedure,Therapeutic, Stent insertionCardiovascular catheterization procedure,Therapeutic, Stent re-dilationCardiovascular catheterization procedure,Therapeutic, Transcatheter Fontan completionCardiovascular catheterization procedure,Therapeutic, Transcatheter implantation of valveShunt, Systemic to pulmonary, ModifiedBlalock-Taussig Shunt (MBTS)Shunt, Systemic to pulmonary, Central (shunt fromaorta)Shunt, Systemic to pulmonary, Central (shunt fromaorta) Central shunt with an end-to-sideconnection between the transected main pulmonaryartery and the side of the ascending aorta (i.e.Mee shunt)Shunt, Systemic to pulmonary, Potts - Smith type(descending aorta to pulmonary artery)Shunt, Systemic to pulmonary, OtherShunt, Ligation and takedownShunt, ReoperationPA banding (PAB)PA debandingPA band adjustment
Damus-Kaye-Stansel procedure (DKS) (creation of APanastomosis without arch reconstruction)Bidirectional cavopulmonary anastomosis (BDCPA)(bidirectional Glenn)Glenn (unidirectional cavopulmonary anastomosis)(unidirectional Glenn)Bilateral bidirectional cavopulmonary anastomosis(BBDCPA) (bilateral bidirectional Glenn)HemiFontanSuperior cavopulmonary anastomosis(es) (Glenn orHemiFontan) + Atrioventricular valvuloplastySuperior Cavopulmonary anastomosis(es) + PAreconstructionTakedown of superior cavopulmonary anastomosisHepatic vein to azygous vein connection, DirectHepatic vein to azygous vein connection,Interposition graftKawashima operation (superior cavopulmonaryconnection in setting of interrupted IVC withazygous continuation)Palliation, OtherAttempted fetal intervention, percutaneoustrans-catheter directed at interatrial septumAttempted fetal intervention, percutaneoustrans-catheter directed at aortic valveAttempted fetal intervention, percutaneoustrans-catheter directed at pulmonic valveAttempted fetal intervention "open" (maternallaparotomy with hysterotomy), directed atinteratrial septumAttempted fetal intervention "open" (maternallaparotomy with hysterotomy), directed at aorticvalveAttempted fetal intervention "open" (maternallaparotomy with hysterotomy), directed at pulmonicvalveECMO cannulationECMO decannulationECMO procedureIntraaortic balloon pump (IABP) insertionRight/left heart assist device procedureVAD explantationVAD implantationVAD change outEchocardiography procedure, Sedatedtransesophageal echocardiogramEchocardiography procedure, Sedated transthoracicechocardiogramNon-cardiovascular, Non-thoracic procedure oncardiac patient with cardiac anesthesiaRadiology procedure on cardiac patient, CardiacComputerized Axial Tomography (CT Scan)Radiology procedure on cardiac patient, CardiacMagnetic Resonance Imaging (MRI)Radiology procedure on cardiac patient, DiagnosticradiologyRadiology procedure on cardiac patient,Non-Cardiac Computerized Tomography (CT) oncardiac patientRadiology procedure on cardiac patient,Non-cardiac Magnetic Resonance Imaging (MRI) oncardiac patientRadiology procedure on cardiac patient,Therapeutic radiologyAneurysm, Ventricular, Right, RepairAneurysm, Ventricular, Left, RepairAneurysm, Pulmonary artery, RepairCardiac tumor resectionPulmonary AV fistula repair/occlusionLigation, Pulmonary arteryPulmonary embolectomy, Acute pulmonary embolus
Pulmonary embolectomy, Chronic pulmonary embolusPleural drainage procedurePleural procedure, OtherLigation, Thoracic ductDecorticationEsophageal procedureMediastinal procedureBronchoscopyDiaphragm plicationDiaphragm procedure, OtherVATS (video-assisted thoracoscopic surgery)Minimally invasive procedureBypass for noncardiac lesionDelayed sternal closureMediastinal explorationSternotomy wound drainageIntravascular stent removalRemoval of transcatheter delivered device fromheartRemoval of transcatheter delivered device fromblood vesselThoracotomy, OtherCardiotomy, OtherCardiac procedure, OtherThoracic and/or mediastinal procedure, OtherPeripheral vascular procedure, OtherMiscellaneous procedure, OtherOrgan procurementOther procedure
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 64 of 140
Specify the secondary cardiac procedure (if any) NonePFO, Primary closureASD repair, Primary closureASD repair, PatchASD repair, DeviceASD repair, Patch + PAPVC repairASD, Common atrium (single atrium), SeptationASD creation/enlargementASD partial closureAtrial septal fenestrationAtrial fenestration closureVSD repair, Primary closureVSD repair, PatchVSD repair, DeviceVSD, Multiple, RepairVSD creation/enlargementVentricular septal fenestrationAVC (AVSD) repair, Complete (CAVSD)AVC (AVSD) repair, Intermediate (Transitional)AVC (AVSD) repair, Partial (Incomplete) (PAVSD)Valvuloplasty, Common atrioventricular valveValvuloplasty converted to valve replacement inthe same operation, Common atrioventricular valveValve replacement, Common atrioventricular valveAP window repairPulmonary artery origin from ascending aorta(hemitruncus) repairTruncus arteriosus repairValvuloplasty, Truncal valveValvuloplasty converted to valve replacement inthe same operation, Truncal valveValve replacement, Truncal valveTruncus + Interrupted aortic arch repair (IAA)repairPAPVC repairPAPVC, Scimitar, RepairPAPVC repair, Baffle redirection to left atriumwith systemic vein translocation (Warden) (SVCsewn to right atrial appendage)TAPVC repairTAPVC repair + Shunt - systemic-to-pulmonaryCor triatriatum repairPulmonary venous stenosis repairAtrial baffle procedure (non-Mustard, non-Senning)Anomalous systemic venous connection repairSystemic venous stenosis repairTOF repair, No VentriculotomyTOF repair, Ventriculotomy, Nontransanular patchTOF repair, Ventriculotomy, Transanular patchTOF repair, RV-PA conduitTOF - AVC (AVSD) repairTOF - Absent pulmonary valve repairPulmonary atresia - VSD (including TOF, PA) repairPulmonary atresia - VSD - MAPCA repair, Completesingle stage repair (1 stage that includesbilateral pulmonary unifocalization + VSD closure+ RV to PA connection [with or without conduit])Pulmonary atresia - VSD - MAPCA repair, Statuspost prior complete unifocalization (includes VSDclosure + RV to PA connection [with or withoutconduit])Pulmonary atresia - VSD - MAPCA repair, Statuspost prior incomplete unifocalization (includescompletion of pulmonary unifocalization + VSDclosure + RV to PA connection [with or withoutconduit])Unifocalization MAPCA(s), Bilateral pulmonaryunifocalization - Complete unifocalization (allusable MAPCA[s] are incorporated)Unifocalization MAPCA(s), Bilateral pulmonary
unifocalization - Incomplete unifocalization (notall usable MAPCA[s] are incorporated)Unifocalization MAPCA(s), Unilateral pulmonaryunifocalizationUnifocalization MAPCA(s)Occlusion of MAPCA(s)Valvuloplasty, Tricuspid (do not use this code iftricuspid valve malfunction is secondary toEbstein's anomaly. Use 465Valvuloplasty converted to valve replacement inthe same operation, TricuspidEbstein's repairValve replacement, Tricuspid (TVR)Valve closure, Tricuspid (exclusion,univentricular approach)Valve excision, Tricuspid (without replacement)Valve surgery, Other, TricuspidRVOT procedure1 1/2 ventricular repairPA, reconstruction (plasty), Main (trunk)PA, reconstruction (plasty), Branch, Central(within the hilar bifurcation)PA, reconstruction (plasty), Branch, Peripheral(at or beyond the hilar bifurcation)DCRV repairValvuloplasty, PulmonicValvuloplasty converted to valve replacement inthe same operation, PulmonicValve replacement, Pulmonic (PVR)Valve excision, Pulmonary (without replacement)Valve closure, SemilunarValve surgery, Other, PulmonicConduit placement, RV to PAConduit placement, LV to PAConduit placement, Ventricle to aortaConduit placement, OtherConduit reoperationValvuloplasty, AorticValvuloplasty converted to valve replacement inthe same operation, AorticValvuloplasty converted to valve replacement inthe same operation, Aortic - with Ross procedureValvuloplasty converted to valve replacement inthe same operation, Aortic - with Ross-KonnoprocedureValve replacement, Aortic (AVR)Valve replacement, Aortic (AVR), MechanicalValve replacement, Aortic (AVR), BioprostheticValve replacement, Aortic (AVR), HomograftAortic root replacement, BioprostheticAortic root replacement, MechanicalAortic root replacement, HomograftAortic root replacement, Valve sparingRoss procedureKonno procedureRoss-Konno procedureOther annular enlargement procedureAortic stenosis, Subvalvar, RepairAortic stenosis, Subvalvar, Repair, With myectomyfor IHSSAortic stenosis, Supravalvar, RepairValve surgery, Other, AorticSinus of Valsalva, Aneurysm repairLV to aorta tunnel repairValvuloplasty, MitralValvuloplasty converted to valve replacement inthe same operation, MitralMitral stenosis, Supravalvar mitral ring repairValve replacement, Mitral (MVR)Valve surgery, Other, MitralNorwood procedure
HLHS biventricular repairConduit insertion right ventricle to pulmonaryartery + Intraventricular tunnel left ventricle toneoaorta + arch reconstruction (Rastelli andNorwood type arch reconstruction) (Yasui)Hybrid Approach "Stage 1", Application of RPA &LPA bandsHybrid Approach "Stage 1", Stent placement inarterial duct (PDA)Hybrid Approach "Stage 1", Stent placement inarterial duct (PDA) + application of RPA & LPAbandsHybrid approach "Stage 2", Aortopulmonaryamalgamation + Superior Cavopulmonaryanastomosis(es) + PA Debanding + Aortic archrepair (Norwood [Stage 1] + Superior Cavopulmonaryanastomosis(es) + PA Debanding)Hybrid approach "Stage 2", Aortopulmonaryamalgamation + Superior Cavopulmonaryanastomosis(es) + PA Debanding + Without aorticarch repairHybrid Approach, Transcardiac balloon dilatationHybrid Approach, Transcardiac transcatheter deviceplacementTransplant, HeartTransplant, Heart and lungPartial left ventriculectomy (LV volume reductionsurgery) (Batista)Pericardial drainage procedurePericardiectomyPericardial procedure, OtherFontan, Atrio-pulmonary connectionFontan, Atrio-ventricular connectionFontan, TCPC, Lateral tunnel, FenestratedFontan, TCPC, Lateral tunnel, NonfenestratedFontan, TCPC, External conduit, FenestratedFontan, TCPC, External conduit, NonfenestratedFontan, TCPC, Intra/extracardiac conduit,FenestratedFontan, TCPC, Intra/extracardiac conduit,NonfenestratedFontan, TCPC, External conduit, hepatic veins topulmonary artery, FenestratedFontan, TCPC, External conduit, hepatic veins topulmonary artery, NonfenestratedFontan revision or conversion (Re-do Fontan)Fontan, OtherFontan + Atrioventricular valvuloplastyVentricular septationCongenitally corrected TGA repair, Atrial switchand ASO (double switch)Congenitally corrected TGA repair, Atrial switchand RastelliCongenitally corrected TGA repair, VSD closureCongenitally corrected TGA repair, VSD closure andLV to PA conduitCongenitally corrected TGA repair, OtherArterial switch operation (ASO)Arterial switch operation (ASO) and VSD repairArterial switch procedure + Aortic arch repairArterial switch procedure and VSD repair + Aorticarch repairSenningMustardAtrial baffle procedure, Mustard or SenningrevisionRastelliREVAortic root translocation over left ventricle(Including Nikaidoh procedure)TGA, Other procedures (Kawashima, LV-PA conduit,
other)DORV, Intraventricular tunnel repairDOLV repairCoarctation repair, End to endCoarctation repair, End to end, ExtendedCoarctation repair, Subclavian flapCoarctation repair, Patch aortoplastyCoarctation repair, Interposition graftCoarctation repair, OtherCoarctation repair + VSD repairAortic arch repairAortic arch repair + VSD repairCoronary artery fistula ligationAnomalous origin of coronary artery from pulmonaryartery repairCoronary artery bypassAnomalous aortic origin of coronary artery (AAOCA)repairCoronary artery procedure, OtherInterrupted aortic arch repairPDA closure, SurgicalPDA closure, DeviceVascular ring repairAortopexyPulmonary artery sling repairAortic aneurysm repairAortic dissection repairLung biopsyTransplant, lung(s)Lung procedure, OtherTracheal procedureMuscle flap, Trunk (i.e. intercostal, pectus, orserratus muscle)Muscle flap, Trunk (i.e. latissimus dorsi)Removal, Sternal wireRib excision, CompleteRib excision, PartialSternal fracture, Open treatmentSternal resection, Radical resection of the sternumSternal resection, Radical resection of thesternum with mediastinal lymphadenectomyTumor of chest wall, Excision including ribsTumor of chest wall, Excision including ribs, WithreconstructionTumor of soft tissue of thorax, Excision of deepsubfascial or intramuscular tumorTumor of soft tissue of thorax, Excision ofsubcutaneous tumorTumor of soft tissue of thorax, Radical resectionHyoid myotomy and suspensionMuscle flap, NeckProcedure on neckTumor of soft tissue of neck, Excision of deepsubfascial or intramuscular tumorTumor of soft tissue of neck, Excision ofsubcutaneous tumorTumor of soft tissue of neck, Radical resectionPectus bar removalPectus bar repositioningPectus repair, Minimally invasive repair (Nuss),With thoracoscopyPectus repair, Minimally invasive repair (Nuss),Without thoracoscopyPectus repair, Open repairDivision of scalenus anticus, With resection of acervical ribDivision of scalenus anticus, Without resection ofa cervical ribRib excision, Excision of a cervical ribRib excision, Excision of a cervical rib, Withsympathectomy
Rib excision, Excision of first ribRib excision, Excision of first rib, WithsympathectomyProcedure on thoraxPacemaker implantation, PermanentPacemaker procedureExplantation of pacing systemICD (AICD) implantationICD (AICD) ([automatic] implantable cardioverterdefibrillator) procedureArrhythmia surgery - atrial, Surgical AblationArrhythmia surgery - ventricular, Surgical AblationCardiovascular catheterization procedure,DiagnosticCardiovascular catheterization procedure,Diagnostic, Angiographic data obtainedCardiovascular catheterization procedure,Diagnostic, Electrophysiology alterationCardiovascular catheterization procedure,Diagnostic, Hemodynamic alterationCardiovascular catheterization procedure,Diagnostic, Hemodynamic data obtainedCardiovascular catheterization procedure,Diagnostic, Transluminal test occlusionCardiovascular catheterization procedure,TherapeuticCardiovascular catheterization procedure,Therapeutic, Adjunctive therapyCardiovascular catheterization procedure,Therapeutic, Balloon dilationCardiovascular catheterization procedure,Therapeutic, Balloon valvotomyCardiovascular catheterization procedure,Therapeutic, Coil implantationCardiovascular catheterization procedure,Therapeutic, Device implantationCardiovascular catheterization procedure,Therapeutic, Device implantation attemptedCardiovascular catheterization procedure,Therapeutic, Electrophysiological ablationCardiovascular catheterization procedure,Therapeutic, Intravascular foreign body removalCardiovascular catheterization procedure,Therapeutic, Perforation (establishinginterchamber and/or intervessel communication)Cardiovascular catheterization procedure,Therapeutic, SeptostomyCardiovascular catheterization procedure,Therapeutic, Stent insertionCardiovascular catheterization procedure,Therapeutic, Stent re-dilationCardiovascular catheterization procedure,Therapeutic, Transcatheter Fontan completionCardiovascular catheterization procedure,Therapeutic, Transcatheter implantation of valveShunt, Systemic to pulmonary, ModifiedBlalock-Taussig Shunt (MBTS)Shunt, Systemic to pulmonary, Central (shunt fromaorta)Shunt, Systemic to pulmonary, Central (shunt fromaorta) Central shunt with an end-to-sideconnection between the transected main pulmonaryartery and the side of the ascending aorta (i.e.Mee shunt)Shunt, Systemic to pulmonary, Potts - Smith type(descending aorta to pulmonary artery)Shunt, Systemic to pulmonary, OtherShunt, Ligation and takedownShunt, ReoperationPA banding (PAB)PA debanding
PA band adjustmentDamus-Kaye-Stansel procedure (DKS) (creation of APanastomosis without arch reconstruction)Bidirectional cavopulmonary anastomosis (BDCPA)(bidirectional Glenn)Glenn (unidirectional cavopulmonary anastomosis)(unidirectional Glenn)Bilateral bidirectional cavopulmonary anastomosis(BBDCPA) (bilateral bidirectional Glenn)HemiFontanSuperior cavopulmonary anastomosis(es) (Glenn orHemiFontan) + Atrioventricular valvuloplastySuperior Cavopulmonary anastomosis(es) + PAreconstructionTakedown of superior cavopulmonary anastomosisHepatic vein to azygous vein connection, DirectHepatic vein to azygous vein connection,Interposition graftKawashima operation (superior cavopulmonaryconnection in setting of interrupted IVC withazygous continuation)Palliation, OtherAttempted fetal intervention, percutaneoustrans-catheter directed at interatrial septumAttempted fetal intervention, percutaneoustrans-catheter directed at aortic valveAttempted fetal intervention, percutaneoustrans-catheter directed at pulmonic valveAttempted fetal intervention "open" (maternallaparotomy with hysterotomy), directed atinteratrial septumAttempted fetal intervention "open" (maternallaparotomy with hysterotomy), directed at aorticvalveAttempted fetal intervention "open" (maternallaparotomy with hysterotomy), directed at pulmonicvalveECMO cannulationECMO decannulationECMO procedureIntraaortic balloon pump (IABP) insertionRight/left heart assist device procedureVAD explantationVAD implantationVAD change outEchocardiography procedure, Sedatedtransesophageal echocardiogramEchocardiography procedure, Sedated transthoracicechocardiogramNon-cardiovascular, Non-thoracic procedure oncardiac patient with cardiac anesthesiaRadiology procedure on cardiac patient, CardiacComputerized Axial Tomography (CT Scan)Radiology procedure on cardiac patient, CardiacMagnetic Resonance Imaging (MRI)Radiology procedure on cardiac patient, DiagnosticradiologyRadiology procedure on cardiac patient,Non-Cardiac Computerized Tomography (CT) oncardiac patientRadiology procedure on cardiac patient,Non-cardiac Magnetic Resonance Imaging (MRI) oncardiac patientRadiology procedure on cardiac patient,Therapeutic radiologyAneurysm, Ventricular, Right, RepairAneurysm, Ventricular, Left, RepairAneurysm, Pulmonary artery, RepairCardiac tumor resectionPulmonary AV fistula repair/occlusionLigation, Pulmonary artery
Pulmonary embolectomy, Acute pulmonary embolusPulmonary embolectomy, Chronic pulmonary embolusPleural drainage procedurePleural procedure, OtherLigation, Thoracic ductDecorticationEsophageal procedureMediastinal procedureBronchoscopyDiaphragm plicationDiaphragm procedure, OtherVATS (video-assisted thoracoscopic surgery)Minimally invasive procedureBypass for noncardiac lesionDelayed sternal closureMediastinal explorationSternotomy wound drainageIntravascular stent removalRemoval of transcatheter delivered device fromheartRemoval of transcatheter delivered device fromblood vesselThoracotomy, OtherCardiotomy, OtherCardiac procedure, OtherThoracic and/or mediastinal procedure, OtherPeripheral vascular procedure, OtherMiscellaneous procedure, OtherOrgan procurementOther procedure
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 71 of 140
Specify the other cardiac procedure (if any) NonePFO, Primary closureASD repair, Primary closureASD repair, PatchASD repair, DeviceASD repair, Patch + PAPVC repairASD, Common atrium (single atrium), SeptationASD creation/enlargementASD partial closureAtrial septal fenestrationAtrial fenestration closureVSD repair, Primary closureVSD repair, PatchVSD repair, DeviceVSD, Multiple, RepairVSD creation/enlargementVentricular septal fenestrationAVC (AVSD) repair, Complete (CAVSD)AVC (AVSD) repair, Intermediate (Transitional)AVC (AVSD) repair, Partial (Incomplete) (PAVSD)Valvuloplasty, Common atrioventricular valveValvuloplasty converted to valve replacement inthe same operation, Common atrioventricular valveValve replacement, Common atrioventricular valveAP window repairPulmonary artery origin from ascending aorta(hemitruncus) repairTruncus arteriosus repairValvuloplasty, Truncal valveValvuloplasty converted to valve replacement inthe same operation, Truncal valveValve replacement, Truncal valveTruncus + Interrupted aortic arch repair (IAA)repairPAPVC repairPAPVC, Scimitar, RepairPAPVC repair, Baffle redirection to left atriumwith systemic vein translocation (Warden) (SVCsewn to right atrial appendage)TAPVC repairTAPVC repair + Shunt - systemic-to-pulmonaryCor triatriatum repairPulmonary venous stenosis repairAtrial baffle procedure (non-Mustard, non-Senning)Anomalous systemic venous connection repairSystemic venous stenosis repairTOF repair, No VentriculotomyTOF repair, Ventriculotomy, Nontransanular patchTOF repair, Ventriculotomy, Transanular patchTOF repair, RV-PA conduitTOF - AVC (AVSD) repairTOF - Absent pulmonary valve repairPulmonary atresia - VSD (including TOF, PA) repairPulmonary atresia - VSD - MAPCA repair, Completesingle stage repair (1 stage that includesbilateral pulmonary unifocalization + VSD closure+ RV to PA connection [with or without conduit])Pulmonary atresia - VSD - MAPCA repair, Statuspost prior complete unifocalization (includes VSDclosure + RV to PA connection [with or withoutconduit])Pulmonary atresia - VSD - MAPCA repair, Statuspost prior incomplete unifocalization (includescompletion of pulmonary unifocalization + VSDclosure + RV to PA connection [with or withoutconduit])Unifocalization MAPCA(s), Bilateral pulmonaryunifocalization - Complete unifocalization (allusable MAPCA[s] are incorporated)Unifocalization MAPCA(s), Bilateral pulmonary
unifocalization - Incomplete unifocalization (notall usable MAPCA[s] are incorporated)Unifocalization MAPCA(s), Unilateral pulmonaryunifocalizationUnifocalization MAPCA(s)Occlusion of MAPCA(s)Valvuloplasty, Tricuspid (do not use this code iftricuspid valve malfunction is secondary toEbstein's anomaly. Use 465Valvuloplasty converted to valve replacement inthe same operation, TricuspidEbstein's repairValve replacement, Tricuspid (TVR)Valve closure, Tricuspid (exclusion,univentricular approach)Valve excision, Tricuspid (without replacement)Valve surgery, Other, TricuspidRVOT procedure1 1/2 ventricular repairPA, reconstruction (plasty), Main (trunk)PA, reconstruction (plasty), Branch, Central(within the hilar bifurcation)PA, reconstruction (plasty), Branch, Peripheral(at or beyond the hilar bifurcation)DCRV repairValvuloplasty, PulmonicValvuloplasty converted to valve replacement inthe same operation, PulmonicValve replacement, Pulmonic (PVR)Valve excision, Pulmonary (without replacement)Valve closure, SemilunarValve surgery, Other, PulmonicConduit placement, RV to PAConduit placement, LV to PAConduit placement, Ventricle to aortaConduit placement, OtherConduit reoperationValvuloplasty, AorticValvuloplasty converted to valve replacement inthe same operation, AorticValvuloplasty converted to valve replacement inthe same operation, Aortic - with Ross procedureValvuloplasty converted to valve replacement inthe same operation, Aortic - with Ross-KonnoprocedureValve replacement, Aortic (AVR)Valve replacement, Aortic (AVR), MechanicalValve replacement, Aortic (AVR), BioprostheticValve replacement, Aortic (AVR), HomograftAortic root replacement, BioprostheticAortic root replacement, MechanicalAortic root replacement, HomograftAortic root replacement, Valve sparingRoss procedureKonno procedureRoss-Konno procedureOther annular enlargement procedureAortic stenosis, Subvalvar, RepairAortic stenosis, Subvalvar, Repair, With myectomyfor IHSSAortic stenosis, Supravalvar, RepairValve surgery, Other, AorticSinus of Valsalva, Aneurysm repairLV to aorta tunnel repairValvuloplasty, MitralValvuloplasty converted to valve replacement inthe same operation, MitralMitral stenosis, Supravalvar mitral ring repairValve replacement, Mitral (MVR)Valve surgery, Other, MitralNorwood procedure
HLHS biventricular repairConduit insertion right ventricle to pulmonaryartery + Intraventricular tunnel left ventricle toneoaorta + arch reconstruction (Rastelli andNorwood type arch reconstruction) (Yasui)Hybrid Approach "Stage 1", Application of RPA &LPA bandsHybrid Approach "Stage 1", Stent placement inarterial duct (PDA)Hybrid Approach "Stage 1", Stent placement inarterial duct (PDA) + application of RPA & LPAbandsHybrid approach "Stage 2", Aortopulmonaryamalgamation + Superior Cavopulmonaryanastomosis(es) + PA Debanding + Aortic archrepair (Norwood [Stage 1] + Superior Cavopulmonaryanastomosis(es) + PA Debanding)Hybrid approach "Stage 2", Aortopulmonaryamalgamation + Superior Cavopulmonaryanastomosis(es) + PA Debanding + Without aorticarch repairHybrid Approach, Transcardiac balloon dilatationHybrid Approach, Transcardiac transcatheter deviceplacementTransplant, HeartTransplant, Heart and lungPartial left ventriculectomy (LV volume reductionsurgery) (Batista)Pericardial drainage procedurePericardiectomyPericardial procedure, OtherFontan, Atrio-pulmonary connectionFontan, Atrio-ventricular connectionFontan, TCPC, Lateral tunnel, FenestratedFontan, TCPC, Lateral tunnel, NonfenestratedFontan, TCPC, External conduit, FenestratedFontan, TCPC, External conduit, NonfenestratedFontan, TCPC, Intra/extracardiac conduit,FenestratedFontan, TCPC, Intra/extracardiac conduit,NonfenestratedFontan, TCPC, External conduit, hepatic veins topulmonary artery, FenestratedFontan, TCPC, External conduit, hepatic veins topulmonary artery, NonfenestratedFontan revision or conversion (Re-do Fontan)Fontan, OtherFontan + Atrioventricular valvuloplastyVentricular septationCongenitally corrected TGA repair, Atrial switchand ASO (double switch)Congenitally corrected TGA repair, Atrial switchand RastelliCongenitally corrected TGA repair, VSD closureCongenitally corrected TGA repair, VSD closure andLV to PA conduitCongenitally corrected TGA repair, OtherArterial switch operation (ASO)Arterial switch operation (ASO) and VSD repairArterial switch procedure + Aortic arch repairArterial switch procedure and VSD repair + Aorticarch repairSenningMustardAtrial baffle procedure, Mustard or SenningrevisionRastelliREVAortic root translocation over left ventricle(Including Nikaidoh procedure)TGA, Other procedures (Kawashima, LV-PA conduit,
other)DORV, Intraventricular tunnel repairDOLV repairCoarctation repair, End to endCoarctation repair, End to end, ExtendedCoarctation repair, Subclavian flapCoarctation repair, Patch aortoplastyCoarctation repair, Interposition graftCoarctation repair, OtherCoarctation repair + VSD repairAortic arch repairAortic arch repair + VSD repairCoronary artery fistula ligationAnomalous origin of coronary artery from pulmonaryartery repairCoronary artery bypassAnomalous aortic origin of coronary artery (AAOCA)repairCoronary artery procedure, OtherInterrupted aortic arch repairPDA closure, SurgicalPDA closure, DeviceVascular ring repairAortopexyPulmonary artery sling repairAortic aneurysm repairAortic dissection repairLung biopsyTransplant, lung(s)Lung procedure, OtherTracheal procedureMuscle flap, Trunk (i.e. intercostal, pectus, orserratus muscle)Muscle flap, Trunk (i.e. latissimus dorsi)Removal, Sternal wireRib excision, CompleteRib excision, PartialSternal fracture, Open treatmentSternal resection, Radical resection of the sternumSternal resection, Radical resection of thesternum with mediastinal lymphadenectomyTumor of chest wall, Excision including ribsTumor of chest wall, Excision including ribs, WithreconstructionTumor of soft tissue of thorax, Excision of deepsubfascial or intramuscular tumorTumor of soft tissue of thorax, Excision ofsubcutaneous tumorTumor of soft tissue of thorax, Radical resectionHyoid myotomy and suspensionMuscle flap, NeckProcedure on neckTumor of soft tissue of neck, Excision of deepsubfascial or intramuscular tumorTumor of soft tissue of neck, Excision ofsubcutaneous tumorTumor of soft tissue of neck, Radical resectionPectus bar removalPectus bar repositioningPectus repair, Minimally invasive repair (Nuss),With thoracoscopyPectus repair, Minimally invasive repair (Nuss),Without thoracoscopyPectus repair, Open repairDivision of scalenus anticus, With resection of acervical ribDivision of scalenus anticus, Without resection ofa cervical ribRib excision, Excision of a cervical ribRib excision, Excision of a cervical rib, Withsympathectomy
Rib excision, Excision of first ribRib excision, Excision of first rib, WithsympathectomyProcedure on thoraxPacemaker implantation, PermanentPacemaker procedureExplantation of pacing systemICD (AICD) implantationICD (AICD) ([automatic] implantable cardioverterdefibrillator) procedureArrhythmia surgery - atrial, Surgical AblationArrhythmia surgery - ventricular, Surgical AblationCardiovascular catheterization procedure,DiagnosticCardiovascular catheterization procedure,Diagnostic, Angiographic data obtainedCardiovascular catheterization procedure,Diagnostic, Electrophysiology alterationCardiovascular catheterization procedure,Diagnostic, Hemodynamic alterationCardiovascular catheterization procedure,Diagnostic, Hemodynamic data obtainedCardiovascular catheterization procedure,Diagnostic, Transluminal test occlusionCardiovascular catheterization procedure,TherapeuticCardiovascular catheterization procedure,Therapeutic, Adjunctive therapyCardiovascular catheterization procedure,Therapeutic, Balloon dilationCardiovascular catheterization procedure,Therapeutic, Balloon valvotomyCardiovascular catheterization procedure,Therapeutic, Coil implantationCardiovascular catheterization procedure,Therapeutic, Device implantationCardiovascular catheterization procedure,Therapeutic, Device implantation attemptedCardiovascular catheterization procedure,Therapeutic, Electrophysiological ablationCardiovascular catheterization procedure,Therapeutic, Intravascular foreign body removalCardiovascular catheterization procedure,Therapeutic, Perforation (establishinginterchamber and/or intervessel communication)Cardiovascular catheterization procedure,Therapeutic, SeptostomyCardiovascular catheterization procedure,Therapeutic, Stent insertionCardiovascular catheterization procedure,Therapeutic, Stent re-dilationCardiovascular catheterization procedure,Therapeutic, Transcatheter Fontan completionCardiovascular catheterization procedure,Therapeutic, Transcatheter implantation of valveShunt, Systemic to pulmonary, ModifiedBlalock-Taussig Shunt (MBTS)Shunt, Systemic to pulmonary, Central (shunt fromaorta)Shunt, Systemic to pulmonary, Central (shunt fromaorta) Central shunt with an end-to-sideconnection between the transected main pulmonaryartery and the side of the ascending aorta (i.e.Mee shunt)Shunt, Systemic to pulmonary, Potts - Smith type(descending aorta to pulmonary artery)Shunt, Systemic to pulmonary, OtherShunt, Ligation and takedownShunt, ReoperationPA banding (PAB)PA debanding
PA band adjustmentDamus-Kaye-Stansel procedure (DKS) (creation of APanastomosis without arch reconstruction)Bidirectional cavopulmonary anastomosis (BDCPA)(bidirectional Glenn)Glenn (unidirectional cavopulmonary anastomosis)(unidirectional Glenn)Bilateral bidirectional cavopulmonary anastomosis(BBDCPA) (bilateral bidirectional Glenn)HemiFontanSuperior cavopulmonary anastomosis(es) (Glenn orHemiFontan) + Atrioventricular valvuloplastySuperior Cavopulmonary anastomosis(es) + PAreconstructionTakedown of superior cavopulmonary anastomosisHepatic vein to azygous vein connection, DirectHepatic vein to azygous vein connection,Interposition graftKawashima operation (superior cavopulmonaryconnection in setting of interrupted IVC withazygous continuation)Palliation, OtherAttempted fetal intervention, percutaneoustrans-catheter directed at interatrial septumAttempted fetal intervention, percutaneoustrans-catheter directed at aortic valveAttempted fetal intervention, percutaneoustrans-catheter directed at pulmonic valveAttempted fetal intervention "open" (maternallaparotomy with hysterotomy), directed atinteratrial septumAttempted fetal intervention "open" (maternallaparotomy with hysterotomy), directed at aorticvalveAttempted fetal intervention "open" (maternallaparotomy with hysterotomy), directed at pulmonicvalveECMO cannulationECMO decannulationECMO procedureIntraaortic balloon pump (IABP) insertionRight/left heart assist device procedureVAD explantationVAD implantationVAD change outEchocardiography procedure, Sedatedtransesophageal echocardiogramEchocardiography procedure, Sedated transthoracicechocardiogramNon-cardiovascular, Non-thoracic procedure oncardiac patient with cardiac anesthesiaRadiology procedure on cardiac patient, CardiacComputerized Axial Tomography (CT Scan)Radiology procedure on cardiac patient, CardiacMagnetic Resonance Imaging (MRI)Radiology procedure on cardiac patient, DiagnosticradiologyRadiology procedure on cardiac patient,Non-Cardiac Computerized Tomography (CT) oncardiac patientRadiology procedure on cardiac patient,Non-cardiac Magnetic Resonance Imaging (MRI) oncardiac patientRadiology procedure on cardiac patient,Therapeutic radiologyAneurysm, Ventricular, Right, RepairAneurysm, Ventricular, Left, RepairAneurysm, Pulmonary artery, RepairCardiac tumor resectionPulmonary AV fistula repair/occlusionLigation, Pulmonary artery
Pulmonary embolectomy, Acute pulmonary embolusPulmonary embolectomy, Chronic pulmonary embolusPleural drainage procedurePleural procedure, OtherLigation, Thoracic ductDecorticationEsophageal procedureMediastinal procedureBronchoscopyDiaphragm plicationDiaphragm procedure, OtherVATS (video-assisted thoracoscopic surgery)Minimally invasive procedureBypass for noncardiac lesionDelayed sternal closureMediastinal explorationSternotomy wound drainageIntravascular stent removalRemoval of transcatheter delivered device fromheartRemoval of transcatheter delivered device fromblood vesselThoracotomy, OtherCardiotomy, OtherCardiac procedure, OtherThoracic and/or mediastinal procedure, OtherPeripheral vascular procedure, OtherMiscellaneous procedure, OtherOrgan procurementOther procedure
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 78 of 140
Specify the other cardiac procedure (if any) NonePFO, Primary closureASD repair, Primary closureASD repair, PatchASD repair, DeviceASD repair, Patch + PAPVC repairASD, Common atrium (single atrium), SeptationASD creation/enlargementASD partial closureAtrial septal fenestrationAtrial fenestration closureVSD repair, Primary closureVSD repair, PatchVSD repair, DeviceVSD, Multiple, RepairVSD creation/enlargementVentricular septal fenestrationAVC (AVSD) repair, Complete (CAVSD)AVC (AVSD) repair, Intermediate (Transitional)AVC (AVSD) repair, Partial (Incomplete) (PAVSD)Valvuloplasty, Common atrioventricular valveValvuloplasty converted to valve replacement inthe same operation, Common atrioventricular valveValve replacement, Common atrioventricular valveAP window repairPulmonary artery origin from ascending aorta(hemitruncus) repairTruncus arteriosus repairValvuloplasty, Truncal valveValvuloplasty converted to valve replacement inthe same operation, Truncal valveValve replacement, Truncal valveTruncus + Interrupted aortic arch repair (IAA)repairPAPVC repairPAPVC, Scimitar, RepairPAPVC repair, Baffle redirection to left atriumwith systemic vein translocation (Warden) (SVCsewn to right atrial appendage)TAPVC repairTAPVC repair + Shunt - systemic-to-pulmonaryCor triatriatum repairPulmonary venous stenosis repairAtrial baffle procedure (non-Mustard, non-Senning)Anomalous systemic venous connection repairSystemic venous stenosis repairTOF repair, No VentriculotomyTOF repair, Ventriculotomy, Nontransanular patchTOF repair, Ventriculotomy, Transanular patchTOF repair, RV-PA conduitTOF - AVC (AVSD) repairTOF - Absent pulmonary valve repairPulmonary atresia - VSD (including TOF, PA) repairPulmonary atresia - VSD - MAPCA repair, Completesingle stage repair (1 stage that includesbilateral pulmonary unifocalization + VSD closure+ RV to PA connection [with or without conduit])Pulmonary atresia - VSD - MAPCA repair, Statuspost prior complete unifocalization (includes VSDclosure + RV to PA connection [with or withoutconduit])Pulmonary atresia - VSD - MAPCA repair, Statuspost prior incomplete unifocalization (includescompletion of pulmonary unifocalization + VSDclosure + RV to PA connection [with or withoutconduit])Unifocalization MAPCA(s), Bilateral pulmonaryunifocalization - Complete unifocalization (allusable MAPCA[s] are incorporated)Unifocalization MAPCA(s), Bilateral pulmonary
unifocalization - Incomplete unifocalization (notall usable MAPCA[s] are incorporated)Unifocalization MAPCA(s), Unilateral pulmonaryunifocalizationUnifocalization MAPCA(s)Occlusion of MAPCA(s)Valvuloplasty, Tricuspid (do not use this code iftricuspid valve malfunction is secondary toEbstein's anomaly. Use 465Valvuloplasty converted to valve replacement inthe same operation, TricuspidEbstein's repairValve replacement, Tricuspid (TVR)Valve closure, Tricuspid (exclusion,univentricular approach)Valve excision, Tricuspid (without replacement)Valve surgery, Other, TricuspidRVOT procedure1 1/2 ventricular repairPA, reconstruction (plasty), Main (trunk)PA, reconstruction (plasty), Branch, Central(within the hilar bifurcation)PA, reconstruction (plasty), Branch, Peripheral(at or beyond the hilar bifurcation)DCRV repairValvuloplasty, PulmonicValvuloplasty converted to valve replacement inthe same operation, PulmonicValve replacement, Pulmonic (PVR)Valve excision, Pulmonary (without replacement)Valve closure, SemilunarValve surgery, Other, PulmonicConduit placement, RV to PAConduit placement, LV to PAConduit placement, Ventricle to aortaConduit placement, OtherConduit reoperationValvuloplasty, AorticValvuloplasty converted to valve replacement inthe same operation, AorticValvuloplasty converted to valve replacement inthe same operation, Aortic - with Ross procedureValvuloplasty converted to valve replacement inthe same operation, Aortic - with Ross-KonnoprocedureValve replacement, Aortic (AVR)Valve replacement, Aortic (AVR), MechanicalValve replacement, Aortic (AVR), BioprostheticValve replacement, Aortic (AVR), HomograftAortic root replacement, BioprostheticAortic root replacement, MechanicalAortic root replacement, HomograftAortic root replacement, Valve sparingRoss procedureKonno procedureRoss-Konno procedureOther annular enlargement procedureAortic stenosis, Subvalvar, RepairAortic stenosis, Subvalvar, Repair, With myectomyfor IHSSAortic stenosis, Supravalvar, RepairValve surgery, Other, AorticSinus of Valsalva, Aneurysm repairLV to aorta tunnel repairValvuloplasty, MitralValvuloplasty converted to valve replacement inthe same operation, MitralMitral stenosis, Supravalvar mitral ring repairValve replacement, Mitral (MVR)Valve surgery, Other, MitralNorwood procedure
HLHS biventricular repairConduit insertion right ventricle to pulmonaryartery + Intraventricular tunnel left ventricle toneoaorta + arch reconstruction (Rastelli andNorwood type arch reconstruction) (Yasui)Hybrid Approach "Stage 1", Application of RPA &LPA bandsHybrid Approach "Stage 1", Stent placement inarterial duct (PDA)Hybrid Approach "Stage 1", Stent placement inarterial duct (PDA) + application of RPA & LPAbandsHybrid approach "Stage 2", Aortopulmonaryamalgamation + Superior Cavopulmonaryanastomosis(es) + PA Debanding + Aortic archrepair (Norwood [Stage 1] + Superior Cavopulmonaryanastomosis(es) + PA Debanding)Hybrid approach "Stage 2", Aortopulmonaryamalgamation + Superior Cavopulmonaryanastomosis(es) + PA Debanding + Without aorticarch repairHybrid Approach, Transcardiac balloon dilatationHybrid Approach, Transcardiac transcatheter deviceplacementTransplant, HeartTransplant, Heart and lungPartial left ventriculectomy (LV volume reductionsurgery) (Batista)Pericardial drainage procedurePericardiectomyPericardial procedure, OtherFontan, Atrio-pulmonary connectionFontan, Atrio-ventricular connectionFontan, TCPC, Lateral tunnel, FenestratedFontan, TCPC, Lateral tunnel, NonfenestratedFontan, TCPC, External conduit, FenestratedFontan, TCPC, External conduit, NonfenestratedFontan, TCPC, Intra/extracardiac conduit,FenestratedFontan, TCPC, Intra/extracardiac conduit,NonfenestratedFontan, TCPC, External conduit, hepatic veins topulmonary artery, FenestratedFontan, TCPC, External conduit, hepatic veins topulmonary artery, NonfenestratedFontan revision or conversion (Re-do Fontan)Fontan, OtherFontan + Atrioventricular valvuloplastyVentricular septationCongenitally corrected TGA repair, Atrial switchand ASO (double switch)Congenitally corrected TGA repair, Atrial switchand RastelliCongenitally corrected TGA repair, VSD closureCongenitally corrected TGA repair, VSD closure andLV to PA conduitCongenitally corrected TGA repair, OtherArterial switch operation (ASO)Arterial switch operation (ASO) and VSD repairArterial switch procedure + Aortic arch repairArterial switch procedure and VSD repair + Aorticarch repairSenningMustardAtrial baffle procedure, Mustard or SenningrevisionRastelliREVAortic root translocation over left ventricle(Including Nikaidoh procedure)TGA, Other procedures (Kawashima, LV-PA conduit,
other)DORV, Intraventricular tunnel repairDOLV repairCoarctation repair, End to endCoarctation repair, End to end, ExtendedCoarctation repair, Subclavian flapCoarctation repair, Patch aortoplastyCoarctation repair, Interposition graftCoarctation repair, OtherCoarctation repair + VSD repairAortic arch repairAortic arch repair + VSD repairCoronary artery fistula ligationAnomalous origin of coronary artery from pulmonaryartery repairCoronary artery bypassAnomalous aortic origin of coronary artery (AAOCA)repairCoronary artery procedure, OtherInterrupted aortic arch repairPDA closure, SurgicalPDA closure, DeviceVascular ring repairAortopexyPulmonary artery sling repairAortic aneurysm repairAortic dissection repairLung biopsyTransplant, lung(s)Lung procedure, OtherTracheal procedureMuscle flap, Trunk (i.e. intercostal, pectus, orserratus muscle)Muscle flap, Trunk (i.e. latissimus dorsi)Removal, Sternal wireRib excision, CompleteRib excision, PartialSternal fracture, Open treatmentSternal resection, Radical resection of the sternumSternal resection, Radical resection of thesternum with mediastinal lymphadenectomyTumor of chest wall, Excision including ribsTumor of chest wall, Excision including ribs, WithreconstructionTumor of soft tissue of thorax, Excision of deepsubfascial or intramuscular tumorTumor of soft tissue of thorax, Excision ofsubcutaneous tumorTumor of soft tissue of thorax, Radical resectionHyoid myotomy and suspensionMuscle flap, NeckProcedure on neckTumor of soft tissue of neck, Excision of deepsubfascial or intramuscular tumorTumor of soft tissue of neck, Excision ofsubcutaneous tumorTumor of soft tissue of neck, Radical resectionPectus bar removalPectus bar repositioningPectus repair, Minimally invasive repair (Nuss),With thoracoscopyPectus repair, Minimally invasive repair (Nuss),Without thoracoscopyPectus repair, Open repairDivision of scalenus anticus, With resection of acervical ribDivision of scalenus anticus, Without resection ofa cervical ribRib excision, Excision of a cervical ribRib excision, Excision of a cervical rib, Withsympathectomy
Rib excision, Excision of first ribRib excision, Excision of first rib, WithsympathectomyProcedure on thoraxPacemaker implantation, PermanentPacemaker procedureExplantation of pacing systemICD (AICD) implantationICD (AICD) ([automatic] implantable cardioverterdefibrillator) procedureArrhythmia surgery - atrial, Surgical AblationArrhythmia surgery - ventricular, Surgical AblationCardiovascular catheterization procedure,DiagnosticCardiovascular catheterization procedure,Diagnostic, Angiographic data obtainedCardiovascular catheterization procedure,Diagnostic, Electrophysiology alterationCardiovascular catheterization procedure,Diagnostic, Hemodynamic alterationCardiovascular catheterization procedure,Diagnostic, Hemodynamic data obtainedCardiovascular catheterization procedure,Diagnostic, Transluminal test occlusionCardiovascular catheterization procedure,TherapeuticCardiovascular catheterization procedure,Therapeutic, Adjunctive therapyCardiovascular catheterization procedure,Therapeutic, Balloon dilationCardiovascular catheterization procedure,Therapeutic, Balloon valvotomyCardiovascular catheterization procedure,Therapeutic, Coil implantationCardiovascular catheterization procedure,Therapeutic, Device implantationCardiovascular catheterization procedure,Therapeutic, Device implantation attemptedCardiovascular catheterization procedure,Therapeutic, Electrophysiological ablationCardiovascular catheterization procedure,Therapeutic, Intravascular foreign body removalCardiovascular catheterization procedure,Therapeutic, Perforation (establishinginterchamber and/or intervessel communication)Cardiovascular catheterization procedure,Therapeutic, SeptostomyCardiovascular catheterization procedure,Therapeutic, Stent insertionCardiovascular catheterization procedure,Therapeutic, Stent re-dilationCardiovascular catheterization procedure,Therapeutic, Transcatheter Fontan completionCardiovascular catheterization procedure,Therapeutic, Transcatheter implantation of valveShunt, Systemic to pulmonary, ModifiedBlalock-Taussig Shunt (MBTS)Shunt, Systemic to pulmonary, Central (shunt fromaorta)Shunt, Systemic to pulmonary, Central (shunt fromaorta) Central shunt with an end-to-sideconnection between the transected main pulmonaryartery and the side of the ascending aorta (i.e.Mee shunt)Shunt, Systemic to pulmonary, Potts - Smith type(descending aorta to pulmonary artery)Shunt, Systemic to pulmonary, OtherShunt, Ligation and takedownShunt, ReoperationPA banding (PAB)PA debanding
PA band adjustmentDamus-Kaye-Stansel procedure (DKS) (creation of APanastomosis without arch reconstruction)Bidirectional cavopulmonary anastomosis (BDCPA)(bidirectional Glenn)Glenn (unidirectional cavopulmonary anastomosis)(unidirectional Glenn)Bilateral bidirectional cavopulmonary anastomosis(BBDCPA) (bilateral bidirectional Glenn)HemiFontanSuperior cavopulmonary anastomosis(es) (Glenn orHemiFontan) + Atrioventricular valvuloplastySuperior Cavopulmonary anastomosis(es) + PAreconstructionTakedown of superior cavopulmonary anastomosisHepatic vein to azygous vein connection, DirectHepatic vein to azygous vein connection,Interposition graftKawashima operation (superior cavopulmonaryconnection in setting of interrupted IVC withazygous continuation)Palliation, OtherAttempted fetal intervention, percutaneoustrans-catheter directed at interatrial septumAttempted fetal intervention, percutaneoustrans-catheter directed at aortic valveAttempted fetal intervention, percutaneoustrans-catheter directed at pulmonic valveAttempted fetal intervention "open" (maternallaparotomy with hysterotomy), directed atinteratrial septumAttempted fetal intervention "open" (maternallaparotomy with hysterotomy), directed at aorticvalveAttempted fetal intervention "open" (maternallaparotomy with hysterotomy), directed at pulmonicvalveECMO cannulationECMO decannulationECMO procedureIntraaortic balloon pump (IABP) insertionRight/left heart assist device procedureVAD explantationVAD implantationVAD change outEchocardiography procedure, Sedatedtransesophageal echocardiogramEchocardiography procedure, Sedated transthoracicechocardiogramNon-cardiovascular, Non-thoracic procedure oncardiac patient with cardiac anesthesiaRadiology procedure on cardiac patient, CardiacComputerized Axial Tomography (CT Scan)Radiology procedure on cardiac patient, CardiacMagnetic Resonance Imaging (MRI)Radiology procedure on cardiac patient, DiagnosticradiologyRadiology procedure on cardiac patient,Non-Cardiac Computerized Tomography (CT) oncardiac patientRadiology procedure on cardiac patient,Non-cardiac Magnetic Resonance Imaging (MRI) oncardiac patientRadiology procedure on cardiac patient,Therapeutic radiologyAneurysm, Ventricular, Right, RepairAneurysm, Ventricular, Left, RepairAneurysm, Pulmonary artery, RepairCardiac tumor resectionPulmonary AV fistula repair/occlusionLigation, Pulmonary artery
Pulmonary embolectomy, Acute pulmonary embolusPulmonary embolectomy, Chronic pulmonary embolusPleural drainage procedurePleural procedure, OtherLigation, Thoracic ductDecorticationEsophageal procedureMediastinal procedureBronchoscopyDiaphragm plicationDiaphragm procedure, OtherVATS (video-assisted thoracoscopic surgery)Minimally invasive procedureBypass for noncardiac lesionDelayed sternal closureMediastinal explorationSternotomy wound drainageIntravascular stent removalRemoval of transcatheter delivered device fromheartRemoval of transcatheter delivered device fromblood vesselThoracotomy, OtherCardiotomy, OtherCardiac procedure, OtherThoracic and/or mediastinal procedure, OtherPeripheral vascular procedure, OtherMiscellaneous procedure, OtherOrgan procurementOther procedure
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 85 of 140
Specify the other cardiac procedure (if any) NonePFO, Primary closureASD repair, Primary closureASD repair, PatchASD repair, DeviceASD repair, Patch + PAPVC repairASD, Common atrium (single atrium), SeptationASD creation/enlargementASD partial closureAtrial septal fenestrationAtrial fenestration closureVSD repair, Primary closureVSD repair, PatchVSD repair, DeviceVSD, Multiple, RepairVSD creation/enlargementVentricular septal fenestrationAVC (AVSD) repair, Complete (CAVSD)AVC (AVSD) repair, Intermediate (Transitional)AVC (AVSD) repair, Partial (Incomplete) (PAVSD)Valvuloplasty, Common atrioventricular valveValvuloplasty converted to valve replacement inthe same operation, Common atrioventricular valveValve replacement, Common atrioventricular valveAP window repairPulmonary artery origin from ascending aorta(hemitruncus) repairTruncus arteriosus repairValvuloplasty, Truncal valveValvuloplasty converted to valve replacement inthe same operation, Truncal valveValve replacement, Truncal valveTruncus + Interrupted aortic arch repair (IAA)repairPAPVC repairPAPVC, Scimitar, RepairPAPVC repair, Baffle redirection to left atriumwith systemic vein translocation (Warden) (SVCsewn to right atrial appendage)TAPVC repairTAPVC repair + Shunt - systemic-to-pulmonaryCor triatriatum repairPulmonary venous stenosis repairAtrial baffle procedure (non-Mustard, non-Senning)Anomalous systemic venous connection repairSystemic venous stenosis repairTOF repair, No VentriculotomyTOF repair, Ventriculotomy, Nontransanular patchTOF repair, Ventriculotomy, Transanular patchTOF repair, RV-PA conduitTOF - AVC (AVSD) repairTOF - Absent pulmonary valve repairPulmonary atresia - VSD (including TOF, PA) repairPulmonary atresia - VSD - MAPCA repair, Completesingle stage repair (1 stage that includesbilateral pulmonary unifocalization + VSD closure+ RV to PA connection [with or without conduit])Pulmonary atresia - VSD - MAPCA repair, Statuspost prior complete unifocalization (includes VSDclosure + RV to PA connection [with or withoutconduit])Pulmonary atresia - VSD - MAPCA repair, Statuspost prior incomplete unifocalization (includescompletion of pulmonary unifocalization + VSDclosure + RV to PA connection [with or withoutconduit])Unifocalization MAPCA(s), Bilateral pulmonaryunifocalization - Complete unifocalization (allusable MAPCA[s] are incorporated)Unifocalization MAPCA(s), Bilateral pulmonary
unifocalization - Incomplete unifocalization (notall usable MAPCA[s] are incorporated)Unifocalization MAPCA(s), Unilateral pulmonaryunifocalizationUnifocalization MAPCA(s)Occlusion of MAPCA(s)Valvuloplasty, Tricuspid (do not use this code iftricuspid valve malfunction is secondary toEbstein's anomaly. Use 465Valvuloplasty converted to valve replacement inthe same operation, TricuspidEbstein's repairValve replacement, Tricuspid (TVR)Valve closure, Tricuspid (exclusion,univentricular approach)Valve excision, Tricuspid (without replacement)Valve surgery, Other, TricuspidRVOT procedure1 1/2 ventricular repairPA, reconstruction (plasty), Main (trunk)PA, reconstruction (plasty), Branch, Central(within the hilar bifurcation)PA, reconstruction (plasty), Branch, Peripheral(at or beyond the hilar bifurcation)DCRV repairValvuloplasty, PulmonicValvuloplasty converted to valve replacement inthe same operation, PulmonicValve replacement, Pulmonic (PVR)Valve excision, Pulmonary (without replacement)Valve closure, SemilunarValve surgery, Other, PulmonicConduit placement, RV to PAConduit placement, LV to PAConduit placement, Ventricle to aortaConduit placement, OtherConduit reoperationValvuloplasty, AorticValvuloplasty converted to valve replacement inthe same operation, AorticValvuloplasty converted to valve replacement inthe same operation, Aortic - with Ross procedureValvuloplasty converted to valve replacement inthe same operation, Aortic - with Ross-KonnoprocedureValve replacement, Aortic (AVR)Valve replacement, Aortic (AVR), MechanicalValve replacement, Aortic (AVR), BioprostheticValve replacement, Aortic (AVR), HomograftAortic root replacement, BioprostheticAortic root replacement, MechanicalAortic root replacement, HomograftAortic root replacement, Valve sparingRoss procedureKonno procedureRoss-Konno procedureOther annular enlargement procedureAortic stenosis, Subvalvar, RepairAortic stenosis, Subvalvar, Repair, With myectomyfor IHSSAortic stenosis, Supravalvar, RepairValve surgery, Other, AorticSinus of Valsalva, Aneurysm repairLV to aorta tunnel repairValvuloplasty, MitralValvuloplasty converted to valve replacement inthe same operation, MitralMitral stenosis, Supravalvar mitral ring repairValve replacement, Mitral (MVR)Valve surgery, Other, MitralNorwood procedure
HLHS biventricular repairConduit insertion right ventricle to pulmonaryartery + Intraventricular tunnel left ventricle toneoaorta + arch reconstruction (Rastelli andNorwood type arch reconstruction) (Yasui)Hybrid Approach "Stage 1", Application of RPA &LPA bandsHybrid Approach "Stage 1", Stent placement inarterial duct (PDA)Hybrid Approach "Stage 1", Stent placement inarterial duct (PDA) + application of RPA & LPAbandsHybrid approach "Stage 2", Aortopulmonaryamalgamation + Superior Cavopulmonaryanastomosis(es) + PA Debanding + Aortic archrepair (Norwood [Stage 1] + Superior Cavopulmonaryanastomosis(es) + PA Debanding)Hybrid approach "Stage 2", Aortopulmonaryamalgamation + Superior Cavopulmonaryanastomosis(es) + PA Debanding + Without aorticarch repairHybrid Approach, Transcardiac balloon dilatationHybrid Approach, Transcardiac transcatheter deviceplacementTransplant, HeartTransplant, Heart and lungPartial left ventriculectomy (LV volume reductionsurgery) (Batista)Pericardial drainage procedurePericardiectomyPericardial procedure, OtherFontan, Atrio-pulmonary connectionFontan, Atrio-ventricular connectionFontan, TCPC, Lateral tunnel, FenestratedFontan, TCPC, Lateral tunnel, NonfenestratedFontan, TCPC, External conduit, FenestratedFontan, TCPC, External conduit, NonfenestratedFontan, TCPC, Intra/extracardiac conduit,FenestratedFontan, TCPC, Intra/extracardiac conduit,NonfenestratedFontan, TCPC, External conduit, hepatic veins topulmonary artery, FenestratedFontan, TCPC, External conduit, hepatic veins topulmonary artery, NonfenestratedFontan revision or conversion (Re-do Fontan)Fontan, OtherFontan + Atrioventricular valvuloplastyVentricular septationCongenitally corrected TGA repair, Atrial switchand ASO (double switch)Congenitally corrected TGA repair, Atrial switchand RastelliCongenitally corrected TGA repair, VSD closureCongenitally corrected TGA repair, VSD closure andLV to PA conduitCongenitally corrected TGA repair, OtherArterial switch operation (ASO)Arterial switch operation (ASO) and VSD repairArterial switch procedure + Aortic arch repairArterial switch procedure and VSD repair + Aorticarch repairSenningMustardAtrial baffle procedure, Mustard or SenningrevisionRastelliREVAortic root translocation over left ventricle(Including Nikaidoh procedure)TGA, Other procedures (Kawashima, LV-PA conduit,
other)DORV, Intraventricular tunnel repairDOLV repairCoarctation repair, End to endCoarctation repair, End to end, ExtendedCoarctation repair, Subclavian flapCoarctation repair, Patch aortoplastyCoarctation repair, Interposition graftCoarctation repair, OtherCoarctation repair + VSD repairAortic arch repairAortic arch repair + VSD repairCoronary artery fistula ligationAnomalous origin of coronary artery from pulmonaryartery repairCoronary artery bypassAnomalous aortic origin of coronary artery (AAOCA)repairCoronary artery procedure, OtherInterrupted aortic arch repairPDA closure, SurgicalPDA closure, DeviceVascular ring repairAortopexyPulmonary artery sling repairAortic aneurysm repairAortic dissection repairLung biopsyTransplant, lung(s)Lung procedure, OtherTracheal procedureMuscle flap, Trunk (i.e. intercostal, pectus, orserratus muscle)Muscle flap, Trunk (i.e. latissimus dorsi)Removal, Sternal wireRib excision, CompleteRib excision, PartialSternal fracture, Open treatmentSternal resection, Radical resection of the sternumSternal resection, Radical resection of thesternum with mediastinal lymphadenectomyTumor of chest wall, Excision including ribsTumor of chest wall, Excision including ribs, WithreconstructionTumor of soft tissue of thorax, Excision of deepsubfascial or intramuscular tumorTumor of soft tissue of thorax, Excision ofsubcutaneous tumorTumor of soft tissue of thorax, Radical resectionHyoid myotomy and suspensionMuscle flap, NeckProcedure on neckTumor of soft tissue of neck, Excision of deepsubfascial or intramuscular tumorTumor of soft tissue of neck, Excision ofsubcutaneous tumorTumor of soft tissue of neck, Radical resectionPectus bar removalPectus bar repositioningPectus repair, Minimally invasive repair (Nuss),With thoracoscopyPectus repair, Minimally invasive repair (Nuss),Without thoracoscopyPectus repair, Open repairDivision of scalenus anticus, With resection of acervical ribDivision of scalenus anticus, Without resection ofa cervical ribRib excision, Excision of a cervical ribRib excision, Excision of a cervical rib, Withsympathectomy
Rib excision, Excision of first ribRib excision, Excision of first rib, WithsympathectomyProcedure on thoraxPacemaker implantation, PermanentPacemaker procedureExplantation of pacing systemICD (AICD) implantationICD (AICD) ([automatic] implantable cardioverterdefibrillator) procedureArrhythmia surgery - atrial, Surgical AblationArrhythmia surgery - ventricular, Surgical AblationCardiovascular catheterization procedure,DiagnosticCardiovascular catheterization procedure,Diagnostic, Angiographic data obtainedCardiovascular catheterization procedure,Diagnostic, Electrophysiology alterationCardiovascular catheterization procedure,Diagnostic, Hemodynamic alterationCardiovascular catheterization procedure,Diagnostic, Hemodynamic data obtainedCardiovascular catheterization procedure,Diagnostic, Transluminal test occlusionCardiovascular catheterization procedure,TherapeuticCardiovascular catheterization procedure,Therapeutic, Adjunctive therapyCardiovascular catheterization procedure,Therapeutic, Balloon dilationCardiovascular catheterization procedure,Therapeutic, Balloon valvotomyCardiovascular catheterization procedure,Therapeutic, Coil implantationCardiovascular catheterization procedure,Therapeutic, Device implantationCardiovascular catheterization procedure,Therapeutic, Device implantation attemptedCardiovascular catheterization procedure,Therapeutic, Electrophysiological ablationCardiovascular catheterization procedure,Therapeutic, Intravascular foreign body removalCardiovascular catheterization procedure,Therapeutic, Perforation (establishinginterchamber and/or intervessel communication)Cardiovascular catheterization procedure,Therapeutic, SeptostomyCardiovascular catheterization procedure,Therapeutic, Stent insertionCardiovascular catheterization procedure,Therapeutic, Stent re-dilationCardiovascular catheterization procedure,Therapeutic, Transcatheter Fontan completionCardiovascular catheterization procedure,Therapeutic, Transcatheter implantation of valveShunt, Systemic to pulmonary, ModifiedBlalock-Taussig Shunt (MBTS)Shunt, Systemic to pulmonary, Central (shunt fromaorta)Shunt, Systemic to pulmonary, Central (shunt fromaorta) Central shunt with an end-to-sideconnection between the transected main pulmonaryartery and the side of the ascending aorta (i.e.Mee shunt)Shunt, Systemic to pulmonary, Potts - Smith type(descending aorta to pulmonary artery)Shunt, Systemic to pulmonary, OtherShunt, Ligation and takedownShunt, ReoperationPA banding (PAB)PA debanding
PA band adjustmentDamus-Kaye-Stansel procedure (DKS) (creation of APanastomosis without arch reconstruction)Bidirectional cavopulmonary anastomosis (BDCPA)(bidirectional Glenn)Glenn (unidirectional cavopulmonary anastomosis)(unidirectional Glenn)Bilateral bidirectional cavopulmonary anastomosis(BBDCPA) (bilateral bidirectional Glenn)HemiFontanSuperior cavopulmonary anastomosis(es) (Glenn orHemiFontan) + Atrioventricular valvuloplastySuperior Cavopulmonary anastomosis(es) + PAreconstructionTakedown of superior cavopulmonary anastomosisHepatic vein to azygous vein connection, DirectHepatic vein to azygous vein connection,Interposition graftKawashima operation (superior cavopulmonaryconnection in setting of interrupted IVC withazygous continuation)Palliation, OtherAttempted fetal intervention, percutaneoustrans-catheter directed at interatrial septumAttempted fetal intervention, percutaneoustrans-catheter directed at aortic valveAttempted fetal intervention, percutaneoustrans-catheter directed at pulmonic valveAttempted fetal intervention "open" (maternallaparotomy with hysterotomy), directed atinteratrial septumAttempted fetal intervention "open" (maternallaparotomy with hysterotomy), directed at aorticvalveAttempted fetal intervention "open" (maternallaparotomy with hysterotomy), directed at pulmonicvalveECMO cannulationECMO decannulationECMO procedureIntraaortic balloon pump (IABP) insertionRight/left heart assist device procedureVAD explantationVAD implantationVAD change outEchocardiography procedure, Sedatedtransesophageal echocardiogramEchocardiography procedure, Sedated transthoracicechocardiogramNon-cardiovascular, Non-thoracic procedure oncardiac patient with cardiac anesthesiaRadiology procedure on cardiac patient, CardiacComputerized Axial Tomography (CT Scan)Radiology procedure on cardiac patient, CardiacMagnetic Resonance Imaging (MRI)Radiology procedure on cardiac patient, DiagnosticradiologyRadiology procedure on cardiac patient,Non-Cardiac Computerized Tomography (CT) oncardiac patientRadiology procedure on cardiac patient,Non-cardiac Magnetic Resonance Imaging (MRI) oncardiac patientRadiology procedure on cardiac patient,Therapeutic radiologyAneurysm, Ventricular, Right, RepairAneurysm, Ventricular, Left, RepairAneurysm, Pulmonary artery, RepairCardiac tumor resectionPulmonary AV fistula repair/occlusionLigation, Pulmonary artery
Pulmonary embolectomy, Acute pulmonary embolusPulmonary embolectomy, Chronic pulmonary embolusPleural drainage procedurePleural procedure, OtherLigation, Thoracic ductDecorticationEsophageal procedureMediastinal procedureBronchoscopyDiaphragm plicationDiaphragm procedure, OtherVATS (video-assisted thoracoscopic surgery)Minimally invasive procedureBypass for noncardiac lesionDelayed sternal closureMediastinal explorationSternotomy wound drainageIntravascular stent removalRemoval of transcatheter delivered device fromheartRemoval of transcatheter delivered device fromblood vesselThoracotomy, OtherCardiotomy, OtherCardiac procedure, OtherThoracic and/or mediastinal procedure, OtherPeripheral vascular procedure, OtherMiscellaneous procedure, OtherOrgan procurementOther procedure
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 92 of 140
Specify the other cardiac procedure (if any) NonePFO, Primary closureASD repair, Primary closureASD repair, PatchASD repair, DeviceASD repair, Patch + PAPVC repairASD, Common atrium (single atrium), SeptationASD creation/enlargementASD partial closureAtrial septal fenestrationAtrial fenestration closureVSD repair, Primary closureVSD repair, PatchVSD repair, DeviceVSD, Multiple, RepairVSD creation/enlargementVentricular septal fenestrationAVC (AVSD) repair, Complete (CAVSD)AVC (AVSD) repair, Intermediate (Transitional)AVC (AVSD) repair, Partial (Incomplete) (PAVSD)Valvuloplasty, Common atrioventricular valveValvuloplasty converted to valve replacement inthe same operation, Common atrioventricular valveValve replacement, Common atrioventricular valveAP window repairPulmonary artery origin from ascending aorta(hemitruncus) repairTruncus arteriosus repairValvuloplasty, Truncal valveValvuloplasty converted to valve replacement inthe same operation, Truncal valveValve replacement, Truncal valveTruncus + Interrupted aortic arch repair (IAA)repairPAPVC repairPAPVC, Scimitar, RepairPAPVC repair, Baffle redirection to left atriumwith systemic vein translocation (Warden) (SVCsewn to right atrial appendage)TAPVC repairTAPVC repair + Shunt - systemic-to-pulmonaryCor triatriatum repairPulmonary venous stenosis repairAtrial baffle procedure (non-Mustard, non-Senning)Anomalous systemic venous connection repairSystemic venous stenosis repairTOF repair, No VentriculotomyTOF repair, Ventriculotomy, Nontransanular patchTOF repair, Ventriculotomy, Transanular patchTOF repair, RV-PA conduitTOF - AVC (AVSD) repairTOF - Absent pulmonary valve repairPulmonary atresia - VSD (including TOF, PA) repairPulmonary atresia - VSD - MAPCA repair, Completesingle stage repair (1 stage that includesbilateral pulmonary unifocalization + VSD closure+ RV to PA connection [with or without conduit])Pulmonary atresia - VSD - MAPCA repair, Statuspost prior complete unifocalization (includes VSDclosure + RV to PA connection [with or withoutconduit])Pulmonary atresia - VSD - MAPCA repair, Statuspost prior incomplete unifocalization (includescompletion of pulmonary unifocalization + VSDclosure + RV to PA connection [with or withoutconduit])Unifocalization MAPCA(s), Bilateral pulmonaryunifocalization - Complete unifocalization (allusable MAPCA[s] are incorporated)Unifocalization MAPCA(s), Bilateral pulmonary
unifocalization - Incomplete unifocalization (notall usable MAPCA[s] are incorporated)Unifocalization MAPCA(s), Unilateral pulmonaryunifocalizationUnifocalization MAPCA(s)Occlusion of MAPCA(s)Valvuloplasty, Tricuspid (do not use this code iftricuspid valve malfunction is secondary toEbstein's anomaly. Use 465Valvuloplasty converted to valve replacement inthe same operation, TricuspidEbstein's repairValve replacement, Tricuspid (TVR)Valve closure, Tricuspid (exclusion,univentricular approach)Valve excision, Tricuspid (without replacement)Valve surgery, Other, TricuspidRVOT procedure1 1/2 ventricular repairPA, reconstruction (plasty), Main (trunk)PA, reconstruction (plasty), Branch, Central(within the hilar bifurcation)PA, reconstruction (plasty), Branch, Peripheral(at or beyond the hilar bifurcation)DCRV repairValvuloplasty, PulmonicValvuloplasty converted to valve replacement inthe same operation, PulmonicValve replacement, Pulmonic (PVR)Valve excision, Pulmonary (without replacement)Valve closure, SemilunarValve surgery, Other, PulmonicConduit placement, RV to PAConduit placement, LV to PAConduit placement, Ventricle to aortaConduit placement, OtherConduit reoperationValvuloplasty, AorticValvuloplasty converted to valve replacement inthe same operation, AorticValvuloplasty converted to valve replacement inthe same operation, Aortic - with Ross procedureValvuloplasty converted to valve replacement inthe same operation, Aortic - with Ross-KonnoprocedureValve replacement, Aortic (AVR)Valve replacement, Aortic (AVR), MechanicalValve replacement, Aortic (AVR), BioprostheticValve replacement, Aortic (AVR), HomograftAortic root replacement, BioprostheticAortic root replacement, MechanicalAortic root replacement, HomograftAortic root replacement, Valve sparingRoss procedureKonno procedureRoss-Konno procedureOther annular enlargement procedureAortic stenosis, Subvalvar, RepairAortic stenosis, Subvalvar, Repair, With myectomyfor IHSSAortic stenosis, Supravalvar, RepairValve surgery, Other, AorticSinus of Valsalva, Aneurysm repairLV to aorta tunnel repairValvuloplasty, MitralValvuloplasty converted to valve replacement inthe same operation, MitralMitral stenosis, Supravalvar mitral ring repairValve replacement, Mitral (MVR)Valve surgery, Other, MitralNorwood procedure
HLHS biventricular repairConduit insertion right ventricle to pulmonaryartery + Intraventricular tunnel left ventricle toneoaorta + arch reconstruction (Rastelli andNorwood type arch reconstruction) (Yasui)Hybrid Approach "Stage 1", Application of RPA &LPA bandsHybrid Approach "Stage 1", Stent placement inarterial duct (PDA)Hybrid Approach "Stage 1", Stent placement inarterial duct (PDA) + application of RPA & LPAbandsHybrid approach "Stage 2", Aortopulmonaryamalgamation + Superior Cavopulmonaryanastomosis(es) + PA Debanding + Aortic archrepair (Norwood [Stage 1] + Superior Cavopulmonaryanastomosis(es) + PA Debanding)Hybrid approach "Stage 2", Aortopulmonaryamalgamation + Superior Cavopulmonaryanastomosis(es) + PA Debanding + Without aorticarch repairHybrid Approach, Transcardiac balloon dilatationHybrid Approach, Transcardiac transcatheter deviceplacementTransplant, HeartTransplant, Heart and lungPartial left ventriculectomy (LV volume reductionsurgery) (Batista)Pericardial drainage procedurePericardiectomyPericardial procedure, OtherFontan, Atrio-pulmonary connectionFontan, Atrio-ventricular connectionFontan, TCPC, Lateral tunnel, FenestratedFontan, TCPC, Lateral tunnel, NonfenestratedFontan, TCPC, External conduit, FenestratedFontan, TCPC, External conduit, NonfenestratedFontan, TCPC, Intra/extracardiac conduit,FenestratedFontan, TCPC, Intra/extracardiac conduit,NonfenestratedFontan, TCPC, External conduit, hepatic veins topulmonary artery, FenestratedFontan, TCPC, External conduit, hepatic veins topulmonary artery, NonfenestratedFontan revision or conversion (Re-do Fontan)Fontan, OtherFontan + Atrioventricular valvuloplastyVentricular septationCongenitally corrected TGA repair, Atrial switchand ASO (double switch)Congenitally corrected TGA repair, Atrial switchand RastelliCongenitally corrected TGA repair, VSD closureCongenitally corrected TGA repair, VSD closure andLV to PA conduitCongenitally corrected TGA repair, OtherArterial switch operation (ASO)Arterial switch operation (ASO) and VSD repairArterial switch procedure + Aortic arch repairArterial switch procedure and VSD repair + Aorticarch repairSenningMustardAtrial baffle procedure, Mustard or SenningrevisionRastelliREVAortic root translocation over left ventricle(Including Nikaidoh procedure)TGA, Other procedures (Kawashima, LV-PA conduit,
other)DORV, Intraventricular tunnel repairDOLV repairCoarctation repair, End to endCoarctation repair, End to end, ExtendedCoarctation repair, Subclavian flapCoarctation repair, Patch aortoplastyCoarctation repair, Interposition graftCoarctation repair, OtherCoarctation repair + VSD repairAortic arch repairAortic arch repair + VSD repairCoronary artery fistula ligationAnomalous origin of coronary artery from pulmonaryartery repairCoronary artery bypassAnomalous aortic origin of coronary artery (AAOCA)repairCoronary artery procedure, OtherInterrupted aortic arch repairPDA closure, SurgicalPDA closure, DeviceVascular ring repairAortopexyPulmonary artery sling repairAortic aneurysm repairAortic dissection repairLung biopsyTransplant, lung(s)Lung procedure, OtherTracheal procedureMuscle flap, Trunk (i.e. intercostal, pectus, orserratus muscle)Muscle flap, Trunk (i.e. latissimus dorsi)Removal, Sternal wireRib excision, CompleteRib excision, PartialSternal fracture, Open treatmentSternal resection, Radical resection of the sternumSternal resection, Radical resection of thesternum with mediastinal lymphadenectomyTumor of chest wall, Excision including ribsTumor of chest wall, Excision including ribs, WithreconstructionTumor of soft tissue of thorax, Excision of deepsubfascial or intramuscular tumorTumor of soft tissue of thorax, Excision ofsubcutaneous tumorTumor of soft tissue of thorax, Radical resectionHyoid myotomy and suspensionMuscle flap, NeckProcedure on neckTumor of soft tissue of neck, Excision of deepsubfascial or intramuscular tumorTumor of soft tissue of neck, Excision ofsubcutaneous tumorTumor of soft tissue of neck, Radical resectionPectus bar removalPectus bar repositioningPectus repair, Minimally invasive repair (Nuss),With thoracoscopyPectus repair, Minimally invasive repair (Nuss),Without thoracoscopyPectus repair, Open repairDivision of scalenus anticus, With resection of acervical ribDivision of scalenus anticus, Without resection ofa cervical ribRib excision, Excision of a cervical ribRib excision, Excision of a cervical rib, Withsympathectomy
Rib excision, Excision of first ribRib excision, Excision of first rib, WithsympathectomyProcedure on thoraxPacemaker implantation, PermanentPacemaker procedureExplantation of pacing systemICD (AICD) implantationICD (AICD) ([automatic] implantable cardioverterdefibrillator) procedureArrhythmia surgery - atrial, Surgical AblationArrhythmia surgery - ventricular, Surgical AblationCardiovascular catheterization procedure,DiagnosticCardiovascular catheterization procedure,Diagnostic, Angiographic data obtainedCardiovascular catheterization procedure,Diagnostic, Electrophysiology alterationCardiovascular catheterization procedure,Diagnostic, Hemodynamic alterationCardiovascular catheterization procedure,Diagnostic, Hemodynamic data obtainedCardiovascular catheterization procedure,Diagnostic, Transluminal test occlusionCardiovascular catheterization procedure,TherapeuticCardiovascular catheterization procedure,Therapeutic, Adjunctive therapyCardiovascular catheterization procedure,Therapeutic, Balloon dilationCardiovascular catheterization procedure,Therapeutic, Balloon valvotomyCardiovascular catheterization procedure,Therapeutic, Coil implantationCardiovascular catheterization procedure,Therapeutic, Device implantationCardiovascular catheterization procedure,Therapeutic, Device implantation attemptedCardiovascular catheterization procedure,Therapeutic, Electrophysiological ablationCardiovascular catheterization procedure,Therapeutic, Intravascular foreign body removalCardiovascular catheterization procedure,Therapeutic, Perforation (establishinginterchamber and/or intervessel communication)Cardiovascular catheterization procedure,Therapeutic, SeptostomyCardiovascular catheterization procedure,Therapeutic, Stent insertionCardiovascular catheterization procedure,Therapeutic, Stent re-dilationCardiovascular catheterization procedure,Therapeutic, Transcatheter Fontan completionCardiovascular catheterization procedure,Therapeutic, Transcatheter implantation of valveShunt, Systemic to pulmonary, ModifiedBlalock-Taussig Shunt (MBTS)Shunt, Systemic to pulmonary, Central (shunt fromaorta)Shunt, Systemic to pulmonary, Central (shunt fromaorta) Central shunt with an end-to-sideconnection between the transected main pulmonaryartery and the side of the ascending aorta (i.e.Mee shunt)Shunt, Systemic to pulmonary, Potts - Smith type(descending aorta to pulmonary artery)Shunt, Systemic to pulmonary, OtherShunt, Ligation and takedownShunt, ReoperationPA banding (PAB)PA debanding
PA band adjustmentDamus-Kaye-Stansel procedure (DKS) (creation of APanastomosis without arch reconstruction)Bidirectional cavopulmonary anastomosis (BDCPA)(bidirectional Glenn)Glenn (unidirectional cavopulmonary anastomosis)(unidirectional Glenn)Bilateral bidirectional cavopulmonary anastomosis(BBDCPA) (bilateral bidirectional Glenn)HemiFontanSuperior cavopulmonary anastomosis(es) (Glenn orHemiFontan) + Atrioventricular valvuloplastySuperior Cavopulmonary anastomosis(es) + PAreconstructionTakedown of superior cavopulmonary anastomosisHepatic vein to azygous vein connection, DirectHepatic vein to azygous vein connection,Interposition graftKawashima operation (superior cavopulmonaryconnection in setting of interrupted IVC withazygous continuation)Palliation, OtherAttempted fetal intervention, percutaneoustrans-catheter directed at interatrial septumAttempted fetal intervention, percutaneoustrans-catheter directed at aortic valveAttempted fetal intervention, percutaneoustrans-catheter directed at pulmonic valveAttempted fetal intervention "open" (maternallaparotomy with hysterotomy), directed atinteratrial septumAttempted fetal intervention "open" (maternallaparotomy with hysterotomy), directed at aorticvalveAttempted fetal intervention "open" (maternallaparotomy with hysterotomy), directed at pulmonicvalveECMO cannulationECMO decannulationECMO procedureIntraaortic balloon pump (IABP) insertionRight/left heart assist device procedureVAD explantationVAD implantationVAD change outEchocardiography procedure, Sedatedtransesophageal echocardiogramEchocardiography procedure, Sedated transthoracicechocardiogramNon-cardiovascular, Non-thoracic procedure oncardiac patient with cardiac anesthesiaRadiology procedure on cardiac patient, CardiacComputerized Axial Tomography (CT Scan)Radiology procedure on cardiac patient, CardiacMagnetic Resonance Imaging (MRI)Radiology procedure on cardiac patient, DiagnosticradiologyRadiology procedure on cardiac patient,Non-Cardiac Computerized Tomography (CT) oncardiac patientRadiology procedure on cardiac patient,Non-cardiac Magnetic Resonance Imaging (MRI) oncardiac patientRadiology procedure on cardiac patient,Therapeutic radiologyAneurysm, Ventricular, Right, RepairAneurysm, Ventricular, Left, RepairAneurysm, Pulmonary artery, RepairCardiac tumor resectionPulmonary AV fistula repair/occlusionLigation, Pulmonary artery
Pulmonary embolectomy, Acute pulmonary embolusPulmonary embolectomy, Chronic pulmonary embolusPleural drainage procedurePleural procedure, OtherLigation, Thoracic ductDecorticationEsophageal procedureMediastinal procedureBronchoscopyDiaphragm plicationDiaphragm procedure, OtherVATS (video-assisted thoracoscopic surgery)Minimally invasive procedureBypass for noncardiac lesionDelayed sternal closureMediastinal explorationSternotomy wound drainageIntravascular stent removalRemoval of transcatheter delivered device fromheartRemoval of transcatheter delivered device fromblood vesselThoracotomy, OtherCardiotomy, OtherCardiac procedure, OtherThoracic and/or mediastinal procedure, OtherPeripheral vascular procedure, OtherMiscellaneous procedure, OtherOrgan procurementOther procedure
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 99 of 140
Specify the other cardiac procedure (if any) NonePFO, Primary closureASD repair, Primary closureASD repair, PatchASD repair, DeviceASD repair, Patch + PAPVC repairASD, Common atrium (single atrium), SeptationASD creation/enlargementASD partial closureAtrial septal fenestrationAtrial fenestration closureVSD repair, Primary closureVSD repair, PatchVSD repair, DeviceVSD, Multiple, RepairVSD creation/enlargementVentricular septal fenestrationAVC (AVSD) repair, Complete (CAVSD)AVC (AVSD) repair, Intermediate (Transitional)AVC (AVSD) repair, Partial (Incomplete) (PAVSD)Valvuloplasty, Common atrioventricular valveValvuloplasty converted to valve replacement inthe same operation, Common atrioventricular valveValve replacement, Common atrioventricular valveAP window repairPulmonary artery origin from ascending aorta(hemitruncus) repairTruncus arteriosus repairValvuloplasty, Truncal valveValvuloplasty converted to valve replacement inthe same operation, Truncal valveValve replacement, Truncal valveTruncus + Interrupted aortic arch repair (IAA)repairPAPVC repairPAPVC, Scimitar, RepairPAPVC repair, Baffle redirection to left atriumwith systemic vein translocation (Warden) (SVCsewn to right atrial appendage)TAPVC repairTAPVC repair + Shunt - systemic-to-pulmonaryCor triatriatum repairPulmonary venous stenosis repairAtrial baffle procedure (non-Mustard, non-Senning)Anomalous systemic venous connection repairSystemic venous stenosis repairTOF repair, No VentriculotomyTOF repair, Ventriculotomy, Nontransanular patchTOF repair, Ventriculotomy, Transanular patchTOF repair, RV-PA conduitTOF - AVC (AVSD) repairTOF - Absent pulmonary valve repairPulmonary atresia - VSD (including TOF, PA) repairPulmonary atresia - VSD - MAPCA repair, Completesingle stage repair (1 stage that includesbilateral pulmonary unifocalization + VSD closure+ RV to PA connection [with or without conduit])Pulmonary atresia - VSD - MAPCA repair, Statuspost prior complete unifocalization (includes VSDclosure + RV to PA connection [with or withoutconduit])Pulmonary atresia - VSD - MAPCA repair, Statuspost prior incomplete unifocalization (includescompletion of pulmonary unifocalization + VSDclosure + RV to PA connection [with or withoutconduit])Unifocalization MAPCA(s), Bilateral pulmonaryunifocalization - Complete unifocalization (allusable MAPCA[s] are incorporated)Unifocalization MAPCA(s), Bilateral pulmonary
unifocalization - Incomplete unifocalization (notall usable MAPCA[s] are incorporated)Unifocalization MAPCA(s), Unilateral pulmonaryunifocalizationUnifocalization MAPCA(s)Occlusion of MAPCA(s)Valvuloplasty, Tricuspid (do not use this code iftricuspid valve malfunction is secondary toEbstein's anomaly. Use 465Valvuloplasty converted to valve replacement inthe same operation, TricuspidEbstein's repairValve replacement, Tricuspid (TVR)Valve closure, Tricuspid (exclusion,univentricular approach)Valve excision, Tricuspid (without replacement)Valve surgery, Other, TricuspidRVOT procedure1 1/2 ventricular repairPA, reconstruction (plasty), Main (trunk)PA, reconstruction (plasty), Branch, Central(within the hilar bifurcation)PA, reconstruction (plasty), Branch, Peripheral(at or beyond the hilar bifurcation)DCRV repairValvuloplasty, PulmonicValvuloplasty converted to valve replacement inthe same operation, PulmonicValve replacement, Pulmonic (PVR)Valve excision, Pulmonary (without replacement)Valve closure, SemilunarValve surgery, Other, PulmonicConduit placement, RV to PAConduit placement, LV to PAConduit placement, Ventricle to aortaConduit placement, OtherConduit reoperationValvuloplasty, AorticValvuloplasty converted to valve replacement inthe same operation, AorticValvuloplasty converted to valve replacement inthe same operation, Aortic - with Ross procedureValvuloplasty converted to valve replacement inthe same operation, Aortic - with Ross-KonnoprocedureValve replacement, Aortic (AVR)Valve replacement, Aortic (AVR), MechanicalValve replacement, Aortic (AVR), BioprostheticValve replacement, Aortic (AVR), HomograftAortic root replacement, BioprostheticAortic root replacement, MechanicalAortic root replacement, HomograftAortic root replacement, Valve sparingRoss procedureKonno procedureRoss-Konno procedureOther annular enlargement procedureAortic stenosis, Subvalvar, RepairAortic stenosis, Subvalvar, Repair, With myectomyfor IHSSAortic stenosis, Supravalvar, RepairValve surgery, Other, AorticSinus of Valsalva, Aneurysm repairLV to aorta tunnel repairValvuloplasty, MitralValvuloplasty converted to valve replacement inthe same operation, MitralMitral stenosis, Supravalvar mitral ring repairValve replacement, Mitral (MVR)Valve surgery, Other, MitralNorwood procedure
HLHS biventricular repairConduit insertion right ventricle to pulmonaryartery + Intraventricular tunnel left ventricle toneoaorta + arch reconstruction (Rastelli andNorwood type arch reconstruction) (Yasui)Hybrid Approach "Stage 1", Application of RPA &LPA bandsHybrid Approach "Stage 1", Stent placement inarterial duct (PDA)Hybrid Approach "Stage 1", Stent placement inarterial duct (PDA) + application of RPA & LPAbandsHybrid approach "Stage 2", Aortopulmonaryamalgamation + Superior Cavopulmonaryanastomosis(es) + PA Debanding + Aortic archrepair (Norwood [Stage 1] + Superior Cavopulmonaryanastomosis(es) + PA Debanding)Hybrid approach "Stage 2", Aortopulmonaryamalgamation + Superior Cavopulmonaryanastomosis(es) + PA Debanding + Without aorticarch repairHybrid Approach, Transcardiac balloon dilatationHybrid Approach, Transcardiac transcatheter deviceplacementTransplant, HeartTransplant, Heart and lungPartial left ventriculectomy (LV volume reductionsurgery) (Batista)Pericardial drainage procedurePericardiectomyPericardial procedure, OtherFontan, Atrio-pulmonary connectionFontan, Atrio-ventricular connectionFontan, TCPC, Lateral tunnel, FenestratedFontan, TCPC, Lateral tunnel, NonfenestratedFontan, TCPC, External conduit, FenestratedFontan, TCPC, External conduit, NonfenestratedFontan, TCPC, Intra/extracardiac conduit,FenestratedFontan, TCPC, Intra/extracardiac conduit,NonfenestratedFontan, TCPC, External conduit, hepatic veins topulmonary artery, FenestratedFontan, TCPC, External conduit, hepatic veins topulmonary artery, NonfenestratedFontan revision or conversion (Re-do Fontan)Fontan, OtherFontan + Atrioventricular valvuloplastyVentricular septationCongenitally corrected TGA repair, Atrial switchand ASO (double switch)Congenitally corrected TGA repair, Atrial switchand RastelliCongenitally corrected TGA repair, VSD closureCongenitally corrected TGA repair, VSD closure andLV to PA conduitCongenitally corrected TGA repair, OtherArterial switch operation (ASO)Arterial switch operation (ASO) and VSD repairArterial switch procedure + Aortic arch repairArterial switch procedure and VSD repair + Aorticarch repairSenningMustardAtrial baffle procedure, Mustard or SenningrevisionRastelliREVAortic root translocation over left ventricle(Including Nikaidoh procedure)TGA, Other procedures (Kawashima, LV-PA conduit,
other)DORV, Intraventricular tunnel repairDOLV repairCoarctation repair, End to endCoarctation repair, End to end, ExtendedCoarctation repair, Subclavian flapCoarctation repair, Patch aortoplastyCoarctation repair, Interposition graftCoarctation repair, OtherCoarctation repair + VSD repairAortic arch repairAortic arch repair + VSD repairCoronary artery fistula ligationAnomalous origin of coronary artery from pulmonaryartery repairCoronary artery bypassAnomalous aortic origin of coronary artery (AAOCA)repairCoronary artery procedure, OtherInterrupted aortic arch repairPDA closure, SurgicalPDA closure, DeviceVascular ring repairAortopexyPulmonary artery sling repairAortic aneurysm repairAortic dissection repairLung biopsyTransplant, lung(s)Lung procedure, OtherTracheal procedureMuscle flap, Trunk (i.e. intercostal, pectus, orserratus muscle)Muscle flap, Trunk (i.e. latissimus dorsi)Removal, Sternal wireRib excision, CompleteRib excision, PartialSternal fracture, Open treatmentSternal resection, Radical resection of the sternumSternal resection, Radical resection of thesternum with mediastinal lymphadenectomyTumor of chest wall, Excision including ribsTumor of chest wall, Excision including ribs, WithreconstructionTumor of soft tissue of thorax, Excision of deepsubfascial or intramuscular tumorTumor of soft tissue of thorax, Excision ofsubcutaneous tumorTumor of soft tissue of thorax, Radical resectionHyoid myotomy and suspensionMuscle flap, NeckProcedure on neckTumor of soft tissue of neck, Excision of deepsubfascial or intramuscular tumorTumor of soft tissue of neck, Excision ofsubcutaneous tumorTumor of soft tissue of neck, Radical resectionPectus bar removalPectus bar repositioningPectus repair, Minimally invasive repair (Nuss),With thoracoscopyPectus repair, Minimally invasive repair (Nuss),Without thoracoscopyPectus repair, Open repairDivision of scalenus anticus, With resection of acervical ribDivision of scalenus anticus, Without resection ofa cervical ribRib excision, Excision of a cervical ribRib excision, Excision of a cervical rib, Withsympathectomy
Rib excision, Excision of first ribRib excision, Excision of first rib, WithsympathectomyProcedure on thoraxPacemaker implantation, PermanentPacemaker procedureExplantation of pacing systemICD (AICD) implantationICD (AICD) ([automatic] implantable cardioverterdefibrillator) procedureArrhythmia surgery - atrial, Surgical AblationArrhythmia surgery - ventricular, Surgical AblationCardiovascular catheterization procedure,DiagnosticCardiovascular catheterization procedure,Diagnostic, Angiographic data obtainedCardiovascular catheterization procedure,Diagnostic, Electrophysiology alterationCardiovascular catheterization procedure,Diagnostic, Hemodynamic alterationCardiovascular catheterization procedure,Diagnostic, Hemodynamic data obtainedCardiovascular catheterization procedure,Diagnostic, Transluminal test occlusionCardiovascular catheterization procedure,TherapeuticCardiovascular catheterization procedure,Therapeutic, Adjunctive therapyCardiovascular catheterization procedure,Therapeutic, Balloon dilationCardiovascular catheterization procedure,Therapeutic, Balloon valvotomyCardiovascular catheterization procedure,Therapeutic, Coil implantationCardiovascular catheterization procedure,Therapeutic, Device implantationCardiovascular catheterization procedure,Therapeutic, Device implantation attemptedCardiovascular catheterization procedure,Therapeutic, Electrophysiological ablationCardiovascular catheterization procedure,Therapeutic, Intravascular foreign body removalCardiovascular catheterization procedure,Therapeutic, Perforation (establishinginterchamber and/or intervessel communication)Cardiovascular catheterization procedure,Therapeutic, SeptostomyCardiovascular catheterization procedure,Therapeutic, Stent insertionCardiovascular catheterization procedure,Therapeutic, Stent re-dilationCardiovascular catheterization procedure,Therapeutic, Transcatheter Fontan completionCardiovascular catheterization procedure,Therapeutic, Transcatheter implantation of valveShunt, Systemic to pulmonary, ModifiedBlalock-Taussig Shunt (MBTS)Shunt, Systemic to pulmonary, Central (shunt fromaorta)Shunt, Systemic to pulmonary, Central (shunt fromaorta) Central shunt with an end-to-sideconnection between the transected main pulmonaryartery and the side of the ascending aorta (i.e.Mee shunt)Shunt, Systemic to pulmonary, Potts - Smith type(descending aorta to pulmonary artery)Shunt, Systemic to pulmonary, OtherShunt, Ligation and takedownShunt, ReoperationPA banding (PAB)PA debanding
PA band adjustmentDamus-Kaye-Stansel procedure (DKS) (creation of APanastomosis without arch reconstruction)Bidirectional cavopulmonary anastomosis (BDCPA)(bidirectional Glenn)Glenn (unidirectional cavopulmonary anastomosis)(unidirectional Glenn)Bilateral bidirectional cavopulmonary anastomosis(BBDCPA) (bilateral bidirectional Glenn)HemiFontanSuperior cavopulmonary anastomosis(es) (Glenn orHemiFontan) + Atrioventricular valvuloplastySuperior Cavopulmonary anastomosis(es) + PAreconstructionTakedown of superior cavopulmonary anastomosisHepatic vein to azygous vein connection, DirectHepatic vein to azygous vein connection,Interposition graftKawashima operation (superior cavopulmonaryconnection in setting of interrupted IVC withazygous continuation)Palliation, OtherAttempted fetal intervention, percutaneoustrans-catheter directed at interatrial septumAttempted fetal intervention, percutaneoustrans-catheter directed at aortic valveAttempted fetal intervention, percutaneoustrans-catheter directed at pulmonic valveAttempted fetal intervention "open" (maternallaparotomy with hysterotomy), directed atinteratrial septumAttempted fetal intervention "open" (maternallaparotomy with hysterotomy), directed at aorticvalveAttempted fetal intervention "open" (maternallaparotomy with hysterotomy), directed at pulmonicvalveECMO cannulationECMO decannulationECMO procedureIntraaortic balloon pump (IABP) insertionRight/left heart assist device procedureVAD explantationVAD implantationVAD change outEchocardiography procedure, Sedatedtransesophageal echocardiogramEchocardiography procedure, Sedated transthoracicechocardiogramNon-cardiovascular, Non-thoracic procedure oncardiac patient with cardiac anesthesiaRadiology procedure on cardiac patient, CardiacComputerized Axial Tomography (CT Scan)Radiology procedure on cardiac patient, CardiacMagnetic Resonance Imaging (MRI)Radiology procedure on cardiac patient, DiagnosticradiologyRadiology procedure on cardiac patient,Non-Cardiac Computerized Tomography (CT) oncardiac patientRadiology procedure on cardiac patient,Non-cardiac Magnetic Resonance Imaging (MRI) oncardiac patientRadiology procedure on cardiac patient,Therapeutic radiologyAneurysm, Ventricular, Right, RepairAneurysm, Ventricular, Left, RepairAneurysm, Pulmonary artery, RepairCardiac tumor resectionPulmonary AV fistula repair/occlusionLigation, Pulmonary artery
Pulmonary embolectomy, Acute pulmonary embolusPulmonary embolectomy, Chronic pulmonary embolusPleural drainage procedurePleural procedure, OtherLigation, Thoracic ductDecorticationEsophageal procedureMediastinal procedureBronchoscopyDiaphragm plicationDiaphragm procedure, OtherVATS (video-assisted thoracoscopic surgery)Minimally invasive procedureBypass for noncardiac lesionDelayed sternal closureMediastinal explorationSternotomy wound drainageIntravascular stent removalRemoval of transcatheter delivered device fromheartRemoval of transcatheter delivered device fromblood vesselThoracotomy, OtherCardiotomy, OtherCardiac procedure, OtherThoracic and/or mediastinal procedure, OtherPeripheral vascular procedure, OtherMiscellaneous procedure, OtherOrgan procurementOther procedure
Notes on cardiac procedure __________________________________________
SECTION: DETAILS OF CARDIAC PROCEDURE
Cardiopulmonary bypass time (min) __________________________________
Aortic cross clamp time (min) __________________________________
Cardiac procedure date of discharge __________________________________
Postop hospital stay duration (days) __________________________________
Complications YesNo
Specify the complications __________________________________
SECTION: UPLOADS
Upload de-identified OR report of [studyid](OR date: [carddt])
Upload de-identified discharge summary report of[studyid](OR date: [carddt])
06/04/2017 10:33am www.projectredcap.org
ConfidentialPVS registry
Page 106 of 140
PV surgery
PULMONARY VEIN SURGERY
PV surgery date __________________________________
Age (years) __________________________________(e.g., for age 2 years and 9 months > put "2")
Age (months) __________________________________(e.g., for age 2 years and 11 months > put "11")
Age in years (calculated filed) __________________________________(e.g., for age 2 years & 11 months > this fielddisplays "2.92")
SECTION: INTRAOPERATIVE DETAILSif the specific PV is absent anatomically, select "not applicable"
Surgical procedure on RCPV ConventionalSuturelessPatch-PTFEPatch- pericardiumRedo conventionalRedo suturelessRedo patch-PTFERedo patch- pericardiumOtherNo procedureNot applicable
Specify the other procedure on RCPV __________________________________
Surgical precedure on RUPV ConventionalSuturelessPatch-PTFEPatch- pericardiumRedo conventionalRedo suturelessRedo patch-PTFERedo patch- pericardiumOtherNo procedureNot applicable
Specify the other procedure on RUPV __________________________________
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 107 of 140
Surgical precedure on RLPV ConventionalSuturelessPatch-PTFEPatch- pericardiumRedo conventionalRedo suturelessRedo patch-PTFERedo patch- pericardiumOtherNo procedureNot applicable
Specify the other procedure on RLPV __________________________________
Surgical precedure on RMPV ConventionalSuturelessPatch-PTFEPatch- pericardiumRedo conventionalRedo suturelessRedo patch-PTFERedo patch- pericardiumOtherNo procedureNot applicable
Specify the other procedure on RMPV __________________________________
Surgical precedure on LCPV ConventionalSuturelessPatch-PTFEPatch- pericardiumRedo conventionalRedo suturelessRedo patch-PTFERedo patch- pericardiumOtherNo procedureNot applicable
Specify the other procedure on LCPV __________________________________
Surgical precedure on LUPV ConventionalSuturelessPatch-PTFEPatch- pericardiumRedo conventionalRedo suturelessRedo patch-PTFERedo patch- pericardiumOtherNo procedureNot applicable
Specify the other procedure on LUPV __________________________________
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 108 of 140
Surgical precedure on LLPV ConventionalSuturelessPatch-PTFEPatch- pericardiumRedo conventionalRedo suturelessRedo patch-PTFERedo patch- pericardiumOtherNo procedureNot applicable
Specify the other procedure on LLPV __________________________________
Cardiopulmonary bypass time (min) __________________________________
Aortic cross clamp time (min) __________________________________
Hypothermic circulatory arrest time (min) __________________________________
Any other cardiac surgery during the same OR YesNo
Specify the other cardiac surgery __________________________________________
Comments on pulmonary vein surgery __________________________________________
SECTION: POSTOPERATIVE COURSE
Date of extubation __________________________________
Postop ventilation duration (days) __________________________________
Date of discharge from ICU __________________________________
Postop ICU duration (days) __________________________________
Delayed chest closure YesNo
Extracorporeal life support postoperatively YesNo
Type of extracorporeal life support VA ECMOVV ECMONovalung/PLAD
Date of start of ECLS __________________________________
Date of end of ECLS __________________________________
Medications used for PHTN in the postop period YesNo
Inhaled nitric oxide YesNo
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 109 of 140
Sildenafil YesNo
Other medications for PHTN YesNo
Specify the other medication used __________________________________
Postoperative complications YesNo
Type of complications Infection(select all that apply) Acute kidney injury
Pulmonary hypertensive crisisRight ventricular failureProlonged intubationCerebral embolization/StrokeSystemic embolization to organ other than brainOther complication 1Other complication 2Other complication 3
Specify the other complication 1 __________________________________
Specify the other complication 2 __________________________________
Specify the other complication 3 __________________________________
Comments on PV surgery postop complications __________________________________________
SECTION: UPLOADS
Upload de-identified OR report of [studyid](OR date: [pvsdt])
Upload de-identified discharge summary of [studyid] (OR date: [pvsdt])
06/04/2017 10:33am www.projectredcap.org
ConfidentialPVS registry
Page 110 of 140
PV cath intervention
PULMONARY VEIN CATHETER INTERVENTION
PV cath intervention date __________________________________
Age (years) __________________________________(e.g., for age 2 years and 9 months > put "2")
Age (months) __________________________________(e.g., for age 2 years and 11 months > put "11")
Age in years (calculated filed) __________________________________(e.g., for age 2 years & 11 months > this fielddisplays "2.92")
SECTION: DIAGNOSTIC CATH COMBINED WITH INTERVENTION
RCPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse disease/hypoplasiaAtretic/occludedNo stenosis/unobstructedNot specifiedNot applicable
RUPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse disease/hypoplasiaAtretic/occludedNo stenosis/unobstructedNot specifiedNot applicable
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 111 of 140
RLPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse disease/hypoplasiaAtretic/occludedNo stenosis/unobstructedNot specifiedNot applicable
RMPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse disease/hypoplasiaAtretic/occludedNo stenosis/unobstructedNot specifiedNot applicable
LCPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse disease/hypoplasiaAtretic/occludedNo stenosis/unobstructedNot specifiedNot applicable
LUPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse disease/hypoplasiaAtretic/occludedNo stenosis/unobstructedNot specifiedNot applicable
LLPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse disease/hypoplasiaAtretic/occludedNo stenosis/unobstructedNot specifiedNot applicable
Comments on diagnostic cath __________________________________________
SECTION: INTERVENTION PROCEDURE DETAILSif the specific PV is absent anatomically, select "not applicable"
Catheter based procedure on RCPV Dilation onlyDilation requiring cutting balloonsDilation+Stent implantationStent rupture/fracture onlyOtherNo interventionNot applicable
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 112 of 140
Specify the stent on RCPV BMSCoveredDES (Everolimus)DES (Sirolimus)DES (Paclitaxel)DES (other)Bioabsorbable DES
Specify the other drug eluting stent on RCPV __________________________________
Specify the other procedure on RCPV __________________________________
Catheter based procedure on RUPV Dilation onlyDilation requiring cutting balloonsDilation+Stent implantationStent rupture/fracture onlyOtherNo interventionNot applicable
Specify the stent on RUPV BMSCoveredDES (Everolimus)DES (Sirolimus)DES (Paclitaxel)DES (other)Bioabsorbable DES
Specify the other drug eluting stent on RUPV __________________________________
Specify the other procedure on RUPV __________________________________
Catheter based procedure on RLPV Dilation onlyDilation requiring cutting balloonsDilation+Stent implantationStent rupture/fracture onlyOtherNo interventionNot applicable
Specify the stent on RLPV BMSCoveredDES (Everolimus)DES (Sirolimus)DES (Paclitaxel)DES (other)Bioabsorbable DES
Specify the other drug eluting stent on RLPV __________________________________
Specify the other procedure on RLPV __________________________________
Catheter based procedure on RMPV Dilation onlyDilation requiring cutting balloonsDilation+Stent implantationStent rupture/fracture onlyOtherNo interventionNot applicable
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 113 of 140
Specify the stent on RMPV BMSCoveredDES (Everolimus)DES (Sirolimus)DES (Paclitaxel)DES (other)Bioabsorbable DES
Specify the other drug eluting stent on RMPV __________________________________
Specify the other procedure on RMPV __________________________________
Catheter based procedure on LCPV Dilation onlyDilation requiring cutting balloonsDilation+Stent implantationStent rupture/fracture onlyOtherNo interventionNot applicable
Specify the stent on LCPV BMSCoveredDES (Everolimus)DES (Sirolimus)DES (Paclitaxel)DES (other)Bioabsorbable DES
Specify the other drug eluting stent on LCPV __________________________________
Specify the other procedure on LCPV __________________________________
Catheter based procedure on LUPV Dilation onlyDilation requiring cutting balloonsDilation+Stent implantationStent rupture/fracture onlyOtherNo interventionNot applicable
Specify the stent on LUPV BMSCoveredDES (Everolimus)DES (Sirolimus)DES (Paclitaxel)DES (other)Bioabsorbable DES
Specify the other drug eluting stent on LUPV __________________________________
Specify the other procedure on LUPV __________________________________
Catheter based procedure on LLPV Dilation onlyDilation requiring cutting balloonsDilation+Stent implantationStent rupture/fracture onlyOtherNo interventionNot applicable
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 114 of 140
Specify the stent on LLPV BMSCoveredDES (Everolimus)DES (Sirolimus)DES (Paclitaxel)DES (other)Bioabsorbable DES
Specify the other drug eluting stent on LLPV __________________________________
Specify the other procedure on LLPV __________________________________
SECTION: PRE-PROCEDURE CATHETER HEMODYNAMIC PARAMETERS
Pulmonary artery systolic pressure (mmHg) __________________________________
Pulmonary artery diastolic pressure (mmHg) __________________________________
Aortic systolic pressure (mmHg) __________________________________
Aortic diastolic pressure (mmHg) __________________________________
Right ventricular systolic pressure (mmHg) __________________________________
Right ventricular diastolic pressure (mmHg) __________________________________
Left ventricular systolic pressure (mmHg) __________________________________
Left ventricular diastolic pressure (mmHg) __________________________________
Pulmonary arterial wedge pressure (mmHg) __________________________________
Mean left atrial pressure (mmHg) __________________________________
Mean right atrial pressure (mmHg) __________________________________
Pulmonary vascular resistance (indexed) (dynes/cm __________________________________square)
RCPV pressure (mean) (mmHg) __________________________________
RUPV pressure (mean) (mmHg) __________________________________
RLPV pressure (mean) (mmHg) __________________________________
RMPV pressure (mean) (mmHg) __________________________________
LCPV pressure (mean) (mmHg) __________________________________
LUPV pressure (mean) (mmHg) __________________________________
LLPV pressure (mean) (mmHg) __________________________________
Cardiac index (L/min/m2) __________________________________
Flow measurement Individual measurements of pulmonary and systemicblood flowQp:Qs , if individual numbers not reported
Pulmonary blood flow (L/min) __________________________________
Systemic blood flow (L/min) __________________________________
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 115 of 140
Qp __________________________________
Qs __________________________________
SECTION: POST-PROCEDURE CATHETER HEMODYNAMIC PARAMETERS
Pulmonary artery systolic pressure (mmHg) __________________________________
Pulmonary artery diastolic pressure (mmHg) __________________________________
Aortic systolic pressure (mmHg) __________________________________
Aortic diastolic pressure (mmHg) __________________________________
Right ventricular systolic pressure (mmHg) __________________________________
Right ventricular diastolic pressure (mmHg) __________________________________
Left ventricular systolic pressure (mmHg) __________________________________
Left ventricular diastolic pressure (mmHg) __________________________________
Pulmonary arterial wedge pressure (mmHg) __________________________________
Mean left atrial pressure (mmHg) __________________________________
Mean right atrial pressure (mmHg) __________________________________
Pulmonary vascular resistance (indexed) (dynes/cm __________________________________square)
RCPV pressure (mean) (mmHg) __________________________________
RUPV pressure (mean) (mmHg) __________________________________
RLPV pressure (mean) (mmHg) __________________________________
RMPV pressure (mean) (mmHg) __________________________________
LCPV pressure (mean) (mmHg) __________________________________
LUPV pressure (mean) (mmHg) __________________________________
LLPV pressure (mean) (mmHg) __________________________________
Cardiac index (L/min/m2) __________________________________
Flow measurement Individual measurements of pulmonary and systemicblood flowQp:Qs , if individual numbers not reported
Pulmonary blood flow (L/min) __________________________________
Systemic blood flow (L/min) __________________________________
Qp __________________________________
Qs __________________________________
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 116 of 140
Comments on residual lesions after cath basedintervention
__________________________________________
SECTION: COMPLICATIONS
Complications YesNo
Type of complications Infection(select all that apply) Acute kidney injury
Pulmonary hypertensive crisisRight ventricular failureProlonged intubationCerebral embolization/StrokeSystemic embolization to organ other than brainOther complications 1Other complications 2Other complications 3
Specify the other complication 1 __________________________________
Specify the other complication 2 __________________________________
Specify the other complication 3 __________________________________
Comments on PV cath intervention postop complications __________________________________________
SECTION: UPLOADS
Upload de-identified cath report of [studyid](cath date: [cathdt])
Upload de-identified cath report (summary) of[studyid](cath date: [cathdt])
Upload de-identified discharge summary of [studyid](cath date: [cathdt])
06/04/2017 10:33am www.projectredcap.org
ConfidentialPVS registry
Page 117 of 140
Echocardiography
ECHOCARDIOGRAPHY
Echo date __________________________________
Age (years) __________________________________(e.g., for age 2 years and 9 months > put "2")
Age (months) __________________________________(e.g., for age 2 years and 11 months > put "11")
Age in years (calculated filed) __________________________________(e.g., for age 2 years & 11 months > this fielddisplays "2.92")
SECTION: ECHO GENERAL DATA
Imaging Indication Diagnosis / Baseline imagingPost-Intervention surveillanceSurveillance with no previous interventionSymptom driven / Change in clinical status
Type of echocardiography TransthoracicTransesophagealEpicardial
Weight (kg) __________________________________
BSA (kg/m2) __________________________________
SECTION: PV GRADIENTS
Right pulmonary artery flow AntegradeDiastolic flow reversalSystolic flow reversalOther
if other, specify the RPA flow __________________________________
Left pulmonary artery flow AntegradeDiastolic flow reversalSystolic flow reversalOther
if other, specify the LPA flow __________________________________
RCPV mean gradient (mmHg) __________________________________
RCPV peak gradient (mmHg) __________________________________
RUPV mean gradient (mmHg) __________________________________
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 118 of 140
RUPV peak gradient (mmHg) __________________________________
RLPV mean gradient (mmHg) __________________________________
RLPV peak gradient (mmHg) __________________________________
RMPV mean gradient (mmHg) __________________________________
RMPV peak gradient (mmHg) __________________________________
LCPV mean gradient (mmHg) __________________________________
LCPV peak gradient (mmHg) __________________________________
LUPV mean gradient (mmHg) __________________________________
LUPV peak gradient (mmHg) __________________________________
LLPV mean gradient (mmHg) __________________________________
LLPV peak gradient (mmHg) __________________________________
SECTION: PV STENOSIS LOCATION/DESCRIPTIONif the specific PV is absent anatomically, select "not applicable"
RCPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse/hypoplasia onlyAtertic/occludedNo stenosis/unobstructedNot specifiedNot applicable
RUPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse/hypoplasia onlyAtertic/occludedNo stenosis/unobstructedNot specifiedNot applicable
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 119 of 140
RLPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse/hypoplasia onlyAtertic/occludedNo stenosis/unobstructedNot specifiedNot applicable
RMPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse/hypoplasia onlyAtertic/occludedNo stenosis/unobstructedNot specifiedNot applicable
LCPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse/hypoplasia onlyAtertic/occludedNo stenosis/unobstructedNot specifiedNot applicable
LUPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse/hypoplasia onlyAtertic/occludedNo stenosis/unobstructedNot specifiedNot applicable
LLPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse/hypoplasia onlyAtertic/occludedNo stenosis/unobstructedNot specifiedNot applicable
SECTION: CARDIAC FUNCTION/DIMENSIONS
Ejection fraction (%) __________________________________
LV end-diastolic dimension (cm) __________________________________
LV end-systolic dimension (cm) __________________________________
E wave velocity (m/s) __________________________________
A wave velocity (m/s) __________________________________
E' wave velocity (m/s) __________________________________
A' wave velocity (m/s) __________________________________
TAPSE (mm) __________________________________
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 120 of 140
LVET (ms) __________________________________
Right ventricular dysfunction NoneMildModerateSevereNot specified/applicable
Right ventricular enlargement NoneMildModerateSevereNot specified/applicable
RVSP (mmHg) __________________________________
RV FAC% __________________________________
RV end-diastolic dimension (cm) __________________________________
RV end-systolic dimension (cm) __________________________________
Left atrial size (minor axis) (cm) __________________________________
Left atrial size (major axis) (cm) __________________________________
Left atrial volume (ml) __________________________________
Comments on septal motion/ septal curvature NormalFlattened/ D shapedParadoxical septal motionOther
If other, specify the septal motion __________________________________
SECTION: CARDIAC VALVES
Mitral valve regurgitation None/no regurgitationMildModerateSevereNot reported
Aortic valve regurgitation None/no regurgitationMildModerateSevereNot reported
Pulmonary valve regurgitation None/no regurgitationMildModerateSevereNot reported
Tricuspid valve regurgitation None/no regurgitationMildModerateSevereNot reported
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 121 of 140
Left AV valve regurgitation None/no regurgitationMildModerateSevereNot reported
Right AV valve regurgitation None/no regurgitationMildModerateSevereNot reported
Mitral valve stenosis YesNo
Mitral valve stenosis mean gradient (mmHg) __________________________________
Tricuspid valve stenosis YesNo
Tricuspid valve stenosis mean gradient (mmHg) __________________________________
Aortic stenosis YesNo
Aortic stenosis/LVOT mean gradient (mmHg) __________________________________
Pulmonary stenosis YesNo
Pulmonary stenosis/RVOT gradient (mmHg) __________________________________
SECTION: CARDIAC LESIONS
Other cardiac lesions YesNo
Specify other cardiac lesions PDA(select all that apply) VSD
ASDAVSDPFOCor TriatriatumCoarctation of the aortaHLHSDORVRight atrial isomerismTAPVDTOFOther
Specify the other cardiac lesion __________________________________
PDA: size (cm) __________________________________
PDA: mean gradient across (mmHg) __________________________________
PDA: peak gradient across (mmHg) __________________________________
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 122 of 140
PDA: shunt direction Left to rightRight to leftBidirectional
VSD: size (cm) __________________________________
VSD: mean gradient across (mmHg) __________________________________
VSD: peak gradient across (mmHg) __________________________________
VSD: shunt direction Left to rightRight to leftBidirectional
ASD: size (cm) __________________________________
ASD: mean gradient across (mmHg) __________________________________
ASD: peak gradient across (mmHg) __________________________________
ASD: shunt direction Left to rightRight to leftBidirectional
PFO: size (cm) __________________________________
PFO: mean gradient across (mmHg) __________________________________
PFO: peak gradient across (mmHg) __________________________________
PFO: shunt direction Left to rightRight to leftBidirectional
Cor triatriatum: size (cm) __________________________________
Cor triatriatum: mean gradient across (mmHg) __________________________________
Cor triatriatum: peak gradient across (mmHg) __________________________________
Cor triatriatum: shunt direction Left to rightRight to leftBidirectional
COA: size (cm) __________________________________
COA: mean gradient across (mmHg) __________________________________
COA: peak gradient across (mmHg) __________________________________
COA: shunt direction Left to rightRight to leftBidirectional
AVSD type BalancedUnbalancedNot specified
Comments __________________________________________
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 123 of 140
SECTION: UPLOADS
Upload de-identified echo report of [studyid] (echodate: [echdt])
06/04/2017 10:33am www.projectredcap.org
ConfidentialPVS registry
Page 124 of 140
Diagnostic cath
DIAGNOSTIC CATHETERIZATION
Diagnostic catheterization date __________________________________
Age (years) __________________________________(e.g., for age 2 years and 9 months > put "2")
Age (months) __________________________________(e.g., for age 2 years and 11 months > put "11")
Age in years (calculated filed) __________________________________(e.g., for age 2 years & 11 months > this fielddisplays "2.92")
SECTION: GENERAL DATA ON DIAGNOSTIC CATH
Indications for cath Diagnosis / Baseline imagingPost-Intervention surveillanceSurveillance with no previous interventionSymptom driven / Change in clinical status
Height (cm) __________________________________
Weight (cm) __________________________________
SECTION: BASELINE MEASUREMENTS
Fraction of inspired oxygen during baseline __________________________________measurements
Pulmonary artery systolic pressure (mmHg) __________________________________
Pulmonary artery diastolic pressure (mmHg) __________________________________
Aortic systolic pressure (mmHg) __________________________________
Aortic diastolic pressure (mmHg) __________________________________
Pulmonary arterial wedge pressure (mmHg) __________________________________
Mean left atrial pressure (mmHg) __________________________________
Mean right atrial pressure (mmHg) __________________________________
Pulmonary vascular resistance (indexed) (dynes/cm __________________________________square)
Right ventricular systolic pressure (mmHg) __________________________________
Right ventricular diastolic pressure (mmHg) __________________________________
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 125 of 140
Left ventricular systolic pressure (mmHg) __________________________________
Left ventricular diastolic pressure (mmHg) __________________________________
RUPV pressure (mean) (mmHg) __________________________________
RMPV pressure (mean) (mmHg) __________________________________
RLPV pressure (mean) (mmHg) __________________________________
LUPV pressure (mean) (mmHg) __________________________________
LLPV pressure (mean) (mmHg) __________________________________
Cardiac index (L/min/m2) __________________________________
Flow measurement Individual measurements of pulmonary and systemicblood flowQp:Qs , if individual numbers not reported
Pulmonary blood flow (L/min) __________________________________
Systemic blood flow (L/min/m2) __________________________________
Qp __________________________________
Qs __________________________________
SECTION: DESCRIPTION ON PVS
RCPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse disease/hypoplasiaAtretic/occludedNo stenosis/unobstructedNot specifiedNot applicable
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 126 of 140
RUPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse disease/hypoplasiaAtretic/occludedNo stenosis/unobstructedNot specifiedNot applicable
RLPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse disease/hypoplasiaAtretic/occludedNo stenosis/unobstructedNot specifiedNot applicable
RMPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse disease/hypoplasiaAtretic/occludedNo stenosis/unobstructedNot specifiedNot applicable
LCPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse disease/hypoplasiaAtretic/occludedNo stenosis/unobstructedNot specifiedNot applicable
LUPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse disease/hypoplasiaAtretic/occludedNo stenosis/unobstructedNot specifiedNot applicable
LLPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse disease/hypoplasiaAtretic/occludedNo stenosis/unobstructedNot specifiedNot applicable
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 127 of 140
SECTION: PULMONARY HYPERTENSION TEST
Pulmonary hypertension test done YesNo
Agents used to achieve the lowest measurements > 50% oxygen alone> 50% oxygen with nitric oxideOther
Specify the other agent __________________________________
Lowest pulmonary vascular resistance (indexed) (mmHg) __________________________________
Lowest Qp __________________________________
Lowest Qs __________________________________
Lowest mean pulmonary artery pressure (mmHg) __________________________________
Lowest transpulmonary gradient (mmHg) __________________________________
SECTION: COMPLICATIONS POST DIAGNOSTIC CATH
Complications YesNo
Type of complications Infection(select all that apply) Acute kidney injury
Pulmonary hypertensive crisisRight ventricular failureProlonged intubationCerebral embolization/StrokeSystemic embolization to organ other than brainOther complication 1Other complication 2Other complication 3
Specify the other complication 1 __________________________________
Specify the other complication 2 __________________________________
Specify the other complication 3 __________________________________
SECTION: UPLOADS
Upload de-identified cath procedure (hemodynamic)report of [studyid] (cath date: [diagdt])
Upload de-identified cath report (summary) of[studyid](cath date: [diagdt])
Upload de-identified discharge summary of [studyid](cath date: [diagdt])
06/04/2017 10:33am www.projectredcap.org
ConfidentialPVS registry
Page 128 of 140
Lung perfusion scan
LUNG PERFUSION SCAN
Lung perfusion scan date __________________________________
Age (years) __________________________________(e.g., for age 2 years and 9 months > put "2")
Age (months) __________________________________(e.g., for age 2 years and 11 months > put "11")
Age in years (calculated filed) __________________________________(e.g., for age 2 years & 11 months > this fielddisplays "2.92")
SECTION: DATA ON PERFUSION SCAN
Indication for lung perfusion scan Diagnosis / Baseline imagingPost-Intervention surveillanceSurveillance with no previous interventionSymptom driven / Change in clinical status
Height (cm) __________________________________
Weight (kg) __________________________________
Right lung perfusion (%) __________________________________
Left lung perfusion (%) __________________________________
Right upper lung perfusion (%) __________________________________
Right middle perfusion (%) __________________________________
Right lower perfusion (%) __________________________________
Left upper perfusion (%) __________________________________
Left lower perfusion (%) __________________________________
Comments on lung perfusion __________________________________________
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 129 of 140
SECTION: UPLOADS
Upload de-identified scan of [studyid] (scan date:[lungdt])
06/04/2017 10:33am www.projectredcap.org
ConfidentialPVS registry
Page 130 of 140
Cardiac 3D imaging
CARDIAC 3D IMAGING
Cardiac 3D imaging date __________________________________
Age (years) __________________________________(e.g., for age 2 years and 9 months > put "2")
Age (months) __________________________________(e.g., for age 2 years and 11 months > put "11")
Age in years (calculated filed) __________________________________(e.g., for age 2 years & 11 months > this fielddisplays "2.92")
SECTION: PV ANATOMY AND CONNECTIONS IMAGING DATA
Type of 3D imaging CTMRI
Contrast medium used AblavarMultihanceGadovistDotaremNot specifiedOther
PULMONARY VEIN ANATOMY
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 131 of 140
Right sided pulmonary vein anatomy RUPV(check all that apply) RMPV
RLPVRCPVOther
Comment right sided pulmonary vein anatomy andconnection
__________________________________________
Left sided pulmonary vein anatomy LUPV(check all that apply) LLPV
LCPVOther
Comment left sided pulmonary vein anatomy andconnection
__________________________________________
RUPV connection Connected to left atriumConnected to right atriumConnected to common atriumConnected to systemic venous systemNot applicable
RMPV connection Connected to left atriumConnected to right atriumConnected to common atriumConnected to systemic venous systemNot applicable
RLPV connection Connected to left atriumConnected to right atriumConnected to common atriumConnected to systemic venous systemNot applicable
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 132 of 140
RCPV connection Connected to left atriumConnected to right atriumConnected to common atriumConnected to systemic venous systemNot applicable
LUPV connection Connected to left atriumConnected to right atriumConnected to common atriumConnected to systemic venous systemNot applicable
LLPV connection Connected to left atriumConnected to right atriumConnected to common atriumConnected to systemic venous systemNot applicable
LCPV connection Connected to left atriumConnected to right atriumConnected to common atriumConnected to systemic venous systemNot applicable
Specify the abnormal PV connections __________________________________________
Any other connection YesNo
Specify the other connection __________________________________
Specify the connection type for other connection Connected to left atriumConnected to right atriumConnected to common atriumConnected to systemic venous systemNot applicable
DESCRIPTION OF PVS
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 133 of 140
RUPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse disease/hypoplasiaAtretic/occludedNo stenosis/unobstructedNot specifiedNot applicable
RMPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse disease/hypoplasiaAtretic/occludedNo stenosis/unobstructedNot specifiedNot applicable
RLPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse disease/hypoplasiaAtretic/occludedNo stenosis/unobstructedNot specifiedNot applicable
RCPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse disease/hypoplasiaAtretic/occludedNo stenosis/unobstructedNot specifiedNot applicable
LUPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse disease/hypoplasiaAtretic/occludedNo stenosis/unobstructedNot specifiedNot applicable
LLPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse disease/hypoplasiaAtretic/occludedNo stenosis/unobstructedNot specifiedNot applicable
LCPV stenosis Veno-atrial junction onlyVeno-atrial junction withupstream/intraparenchymal diseaseDiffuse disease/hypoplasiaAtretic/occludedNo stenosis/unobstructedNot specifiedNot applicable
Number of stenotic right pulmonary veins (subjective) __________________________________
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 134 of 140
Comments on stenotic right pulmonary veins __________________________________________
Number of stenotic left pulmonary veins (subjective) __________________________________
Comments on stenotic left pulmonary veins __________________________________________
Adjacent structures contributing to external None compressing PVscompression of PV Descending Aorta
Pulmonary arteryRight aortic archLeft aortic archOther structures
Specify the other structure __________________________________
Systemic arterial collaterals No collateralsMajor collateralsMinor collateralsBoth minor and major collaterals
Comments on CT __________________________________________
SECTION: CT UPLOADS
Upload de-identified CT report of [studyid] (CT date:[imgdt])
SECTION: MRI FUNCTIONAL DATA
RV EF (%) __________________________________
RVEDi (ml/m2) __________________________________
RV ESVi (ml/m2) __________________________________
RV SVi (ml/m2) __________________________________
RV mass (g) __________________________________
LV EF (%) __________________________________
LVEDi (ml/m2) __________________________________
LV ESVi (ml/m2) __________________________________
LV SVi (ml/m2) __________________________________
LV mass (g) __________________________________
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 135 of 140
SECTION: MRI FLOW MEASUREMENTS
Descending aortic blood flow (ml/min/m2) __________________________________
Superior vena cava blood flow (ml/min/m2) __________________________________
Inferior vena cava flow (ml/min/m2) __________________________________
RPA net flow (ml/min/m2) __________________________________
RPA forward flow (ml/min/m2) __________________________________
RPA retrograde flow (ml/min/m2) __________________________________
RPA regurgitant fraction (%) __________________________________
LPA net flow (ml/min/m2) __________________________________
LPA forward flow (ml/min/m2) __________________________________
LPA retrograde flow (ml/min/m2) __________________________________
LPA regurgitant fracton (%) __________________________________
Flow ratio (RPA:LPA) __________________________________
Qp __________________________________
Qs __________________________________
Flow suggestive of pulmonary hypertension YesNo
RUPV flow (ml/min/m2) __________________________________
RUPV flow pattern PhasicLoss of phasic patternContinuous flowFast flowFlow not specified/reportedNot applicable
RMPV flow (ml/min/m2) __________________________________
RMPV flow pattern PhasicLoss of phasic patternContinuous flowFast flowFlow not specified/reportedNot applicable
RLPV flow (ml/min/m2) __________________________________
RLPV flow pattern PhasicLoss of phasic patternContinuous flowFast flowFlow not specified/reportedNot applicable
RCPV flow (ml/min/m2) __________________________________
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 136 of 140
RCPV flow pattern PhasicLoss of phasic patternContinuous flowFast flowFlow not specified/reportedNot applicable
LUPV flow (ml/min/m2) __________________________________
LUPV flow pattern PhasicLoss of phasic patternContinuous flowFast flowFlow not specified/reportedNot applicable
LLPV flow (ml/min/m2) __________________________________
LLPV flow pattern PhasicLoss of phasic patternContinuous flowFast flowFlow not specified/reportedNot applicable
LCPV flow (ml/min/m2) __________________________________
LCPV flow pattern PhasicLoss of phasic patternContinuous flowFast flowFlow not specified/reportedNot applicable
Ratio of flow through obstructed PV: ipsilateral __________________________________pulmonary artery
LV ECV fraction on T1 mapping (T1 / ECV LV) __________________________________
RV ECV fraction on T1 mapping (T1 / ECV RV) __________________________________
Septum ECV fraction on T1 mapping (T1 / ECV septum) __________________________________
Comments on MRI __________________________________________
SECTION: MRI UPLOADS
Upload de-identified MRI report of [studyid](MRI date: [imgdt])
06/04/2017 10:33am www.projectredcap.org
ConfidentialPVS registry
Page 137 of 140
Cardiac 3D specialized
CARDIAC 3D IMAGING SPECIALIZED MEASUREMENTS
Cardiac 3D specialized measurements date __________________________________
Age (years) __________________________________(e.g., for age 2 years and 9 months > put "2")
Age (months) __________________________________(e.g., for age 2 years and 11 months > put "11")
Age in years (calculated filed) __________________________________(e.g., for age 2 years & 11 months > this fielddisplays "2.92")
SECTION: THORACIC GEOMETRIC MEASUREMENTS
Antero-posterior dimension (unit?) __________________________________
Horizontal dimension (unit?) __________________________________
Distance from vertebra to aorta __________________________________
Lung dimension (mm2) __________________________________
Right cardiac dimension (mm2) __________________________________
Left cardiac dimension (mm2) __________________________________
Total cardiac dimension (mm2) __________________________________
Right thoracic dimension (mm2) __________________________________
Left thoracic dimension (mm2) __________________________________
Total thoracic dimension (mm2) __________________________________
Comments on thoracic measurements __________________________________________
SECTION: PULMONARY VEIN CROSS SECTIONAL AREA MEASUREMENTS
RUPV veno atrial CSA (mm2/m2) __________________________________
RUPV upsteam CSA (mm2/m2) __________________________________
RMPV veno atrial CSA (mm2/m2) __________________________________
RMPV upstream CSA (mm2/m2) __________________________________
RLPV veno atrial CSA (mm2/m2) __________________________________
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 138 of 140
RLPV upstream CSA (mm2/m2) __________________________________
RCPV veno atrial CSA (mm2/m2) __________________________________
RCPV upstream CSA (mm2/m2) __________________________________
LUPV veno atrial CSA (mm2/m2) __________________________________
LUPV upstream CSA (mm2/m2) __________________________________
LLPV veno atrial CSA (mm2/m2) __________________________________
LLPV upstream CSA (mm2/m2) __________________________________
LCPV veno atrial CSA (mm2/m2) __________________________________
LCPV upstream CSA (mm2/m2) __________________________________
Comments on PV CSA measurements __________________________________________
SECTION: T1 / ECV FOR FIBROSIS MEASUREMENTS
LV ECV fraction on T1 mapping (T1 / ECV LV) __________________________________
RV ECV fraction on T1 mapping (T1 / ECV LV) __________________________________
Septum ECV fraction on T1 mapping (T1 / ECV septum) __________________________________
Comments on fibrosis __________________________________________
SECTION: UPLOADS
Upload de-identified specialized 3D imaging report of[studyid] (scan date: [specdt])
06/04/2017 10:33am www.projectredcap.org
ConfidentialPVS registry
Page 139 of 140
Outcome
OUTCOME
SECTION: LUNG TRANSPLANT AND MECHANICAL SUPPORT
Transplant Not a candidate for lung transplantLung transplant candidate, on waiting listHeart-Lung transplant candidate, on waiting listTransplanted - LungTransplanted - Heart-Lung
Type of lung transplant Single - right lungSingle - left lungDouble
Date of transplant __________________________________
Mechanical support bridge YesNo
Type of mechanical support VV ECMOVA ECMONovalung/PLAD
SECTION: LAST FOLLOW-UP
Status at last follow-up DeadAliveUnknown
Date of last follow-up __________________________________(if patient is not alive, last follow-up date isthe date of death)
Primary cause of death Right heart failure attributed to PVSInfectionDeath attributed to other cardiac diagnosisOther
Specify the other cause(s) of death __________________________________________
Death on transplant waiting list YesNo
Comments on cause(s) of death __________________________________________
06/04/2017 10:33am www.projectredcap.org
ConfidentialPage 140 of 140
Lung complications at last follow up Functional single lung due to unilateral PVSPneumonectomyEpisodes of hemoptysis
Comments on last follow-up status __________________________________________
SECTION: UPLOADS
Upload de-identified last follow up/death summary of[studyid](last follow-up date: [lfudt])