CHIEF COMPLAINT: Completion of decending Aortic repair

PRESENT ILLNESS: This  is a 69-year-old female who underwent an aortic valve
replacement, ascending aorta replacement, total arch replacement
with the implantation of the arch vessels, and elephant trunk
graft on [**2129-5-18**]. She recently underwent a CT scan which
revealed similar results of her dilated distal arch and
descending thoracic aorta measurement as previously recorded.
Therefore, she will be undergoing the 2nd part of her planned
operation.

MEDICAL HISTORY: ascending aortic aneurysm/ aortic insufficiency
s/p aortic valve replacement (25mm [**Company 1543**] Mosaic), ascending
aorta-arch replacement (elephant trunk) [**2129-5-18**]
recurrent syncope
right lower lobe nodule
right upper lobe subpleural plaques
hypercholesterolemia
s/p partial oophorectomy
s/p ligal ligation
s/p removal of sebaceous cyst on neck

MEDICATION ON ADMISSION: Toprol XL 50 mg PO daily
Aspirin 325 mg PO daily

ALLERGIES: Penicillins / Sulfa (Sulfonamide Antibiotics) / Bee Pollens /
Codeine / Epinephrine / Tetanus

PHYSICAL EXAM: Admission:

FAMILY HISTORY: Her family history is non-contributory.

SOCIAL HISTORY: Ms. [**Known lastname 6160**] is a retired human resources manager.
Lives with Husband
[**Name (NI) 1139**]: quit tobacco in [**2105**]
ETOH: occasional wine
Thoracic aneurysm without mention of rupture,Hematoma complicating a procedure,Heart valve replaced by transplant,First degree atrioventricular block,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution
Thoracic aortic aneurysm,Hematoma complic proc,Heart valve transplant,Atriovent block-1st degr,Abn react-anastom/graft,Accid in resident instit
Admission Date:  [**2129-7-26**]              Discharge Date:   [**2129-7-31**]

Date of Birth:  [**2059-10-28**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Penicillins / Sulfa (Sulfonamide Antibiotics) / Bee Pollens /
Codeine / Epinephrine / Tetanus

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Completion of decending Aortic repair

Major Surgical or Invasive Procedure:
[**2129-7-26**] Repair of descending thoracic aortic aneurysm with
completion elephant trunk procedure via left thoracotomy and
partial right heart bypass using the existing 28 mm Vascutek
Dacron graft used for the original elephant trunk procedure

History of Present Illness:
This  is a 69-year-old female who underwent an aortic valve
replacement, ascending aorta replacement, total arch replacement
with the implantation of the arch vessels, and elephant trunk
graft on [**2129-5-18**]. She recently underwent a CT scan which
revealed similar results of her dilated distal arch and
descending thoracic aorta measurement as previously recorded.
Therefore, she will be undergoing the 2nd part of her planned
operation.

Past Medical History:
ascending aortic aneurysm/ aortic insufficiency
s/p aortic valve replacement (25mm [**Company 1543**] Mosaic), ascending
aorta-arch replacement (elephant trunk) [**2129-5-18**]
recurrent syncope
right lower lobe nodule
right upper lobe subpleural plaques
hypercholesterolemia
s/p partial oophorectomy
s/p ligal ligation
s/p removal of sebaceous cyst on neck

Social History:
Ms. [**Known lastname 6160**] is a retired human resources manager.
Lives with Husband
[**Name (NI) 1139**]: quit tobacco in [**2105**]
ETOH: occasional wine

Family History:
Her family history is non-contributory.

Physical Exam:
Admission:

Pulse: 75 Resp: 16 O2 sat: 98% RA
B/P  Right: 152/87   Left:
Height: 63"    Weight: 54 kg

General:
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x] well-healed mediansterotomy
incision, stable sternum
Heart: RRR [x]  Irregular []  Murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema Varicosities:
None []
Neuro: Grossly intact
Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right: 1+  Left: 1+
PT           [**Name (NI) 167**]: 1+  Left: 1+
Radial       Right: 1+  Left: 1+

Carotid Bruit        Right: no   Left: no

Pertinent Results:
[**2129-7-28**] 02:24AM BLOOD WBC-7.4 RBC-2.71* Hgb-8.2* Hct-23.6*
MCV-87 MCH-30.1 MCHC-34.6 RDW-14.7 Plt Ct-140*
[**2129-7-28**] 02:24AM BLOOD Glucose-108* UreaN-15 Creat-0.7 Na-133
K-4.2 Cl-101 HCO3-27 AnGap-9

Brief Hospital Course:
Mrs. [**Known lastname 6160**] was a same day admit after undergoing all
pre-operative work-up as an outpatient. On the day of admission
she was brought to the Operating Room where she underwent repair
of the descending thoracic aortic aneurysm with completion
elephant trunk procedure via left thoracotomy. There was a
noticeable right gri=oin hematoma at the end of the case and the
groin wa explored. Please see operative report for surgical
details. Following surgery she was transferred to the CVICU for
invasive monitoring in stable condition on Propofol and
phenylephrine. Within 24 hours she was weaned from sedation,
awoke neurologically intact and extubated.

She was transferred to the floor on POD 2.  Her CTs were removed
on POD 2 and the JP drain on POD 3.  CXR demonstrated no
pneumothorax afterward.  Physical therapy worked with her for
mobilization and she progressed nicely.  She was ready for
discharge on POD 4.

Medications, followup and limitations were discussed with her
prior to discharge.  wounds were clean and healing well and a
regular diet was being tolerated.

Medications on Admission:
Toprol XL 50 mg PO daily
Aspirin 325 mg PO daily

Discharge Medications:


1. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) for 2 weeks.
Disp:*28 Tablet(s)* Refills:*0*
2. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain.
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain for 4 weeks.
Disp:*50 Tablet(s)* Refills:*0*
6. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO DAILY (Daily) as needed for constipation.
7. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
HS (at bedtime) as needed for constipation.
8. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day for 10
days.
Disp:*10 Tablet(s)* Refills:*2*
9. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 10
days.
Disp:*10 Tab Sust.Rel. Particle/Crystal(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 3765**] Homecare

Discharge Diagnosis:
Ascending and descending Aortic Aneurysms
s/p Repair of descending thoracic aortic aneurysm with
completion elephant trunk procedure via left thoracotomy,
exploration of right groin
Recurrent syncope
Right lower lobe nodule
Right upper lobe subpleural plaques
hypercholesterolemia
s/p Aortic valve replacement (25mm [**Company 1543**] Mosaic), ascending
aorta-arch replacement (elephant trunk) [**2129-5-18**]
s/p partial oophorectomy
s/p ligal ligation
s/p removal of sebaceous cyst on neck


Discharge Condition:
Good

Discharge Instructions:
shower daily, no baths or swimming
no lotions, creams or powders to incisions
no driving for 4 weeks and off all narcotics
no lifting more than 10 pounds for 10 weeks
report any redness of, or drainage from incisions
report any fever greater than 100.5
report any weight gain greater than 2 pounds a day or 5 pounds a
week
take all medications as directed

Followup Instructions:
Dr. [**Last Name (STitle) 914**] in 4 weeks ([**Telephone/Fax (1) 170**])
Dr. [**Last Name (STitle) **] in [**3-8**] weeks
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 18920**] in [**2-4**] weeks ([**Telephone/Fax (1) 81289**])
[**Hospital Ward Name 121**] 6 for wound check in 2 weeks
Please call for appointments



Completed by:[**2129-7-30**]
{'Thoracic aneurysm without mention of rupture,Hematoma complicating a procedure,Heart valve replaced by transplant,First degree atrioventricular block,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: Completion of decending Aortic repair

PRESENT ILLNESS: This  is a 69-year-old female who underwent an aortic valve
replacement, ascending aorta replacement, total arch replacement
with the implantation of the arch vessels, and elephant trunk
graft on [**2129-5-18**]. She recently underwent a CT scan which
revealed similar results of her dilated distal arch and
descending thoracic aorta measurement as previously recorded.
Therefore, she will be undergoing the 2nd part of her planned
operation.

MEDICAL HISTORY: ascending aortic aneurysm/ aortic insufficiency
s/p aortic valve replacement (25mm [**Company 1543**] Mosaic), ascending
aorta-arch replacement (elephant trunk) [**2129-5-18**]
recurrent syncope
right lower lobe nodule
right upper lobe subpleural plaques
hypercholesterolemia
s/p partial oophorectomy
s/p ligal ligation
s/p removal of sebaceous cyst on neck

MEDICATION ON ADMISSION: Toprol XL 50 mg PO daily
Aspirin 325 mg PO daily

ALLERGIES: Penicillins / Sulfa (Sulfonamide Antibiotics) / Bee Pollens /
Codeine / Epinephrine / Tetanus

PHYSICAL EXAM: Admission:

FAMILY HISTORY: Her family history is non-contributory.

SOCIAL HISTORY: Ms. [**Known lastname 6160**] is a retired human resources manager.
Lives with Husband
[**Name (NI) 1139**]: quit tobacco in [**2105**]
ETOH: occasional wine 

### Response:
{'Thoracic aneurysm without mention of rupture,Hematoma complicating a procedure,Heart valve replaced by transplant,First degree atrioventricular block,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution'}
