CHIEF COMPLAINT: Dilated aortic root

PRESENT ILLNESS: The patient is a 46-year-old woman who 11 years ago underwent a
mitral valve replacement with a mechanical prosthesis.
Approximately a year-and-a-half ago she presented with an acute
type A aortic dissection. The patient underwent
Dacron tube graft replacement of her ascending aorta from the
sinotubular junction to the mid aortic arch. The patient was
coagulopathic and needed to be reopened in the ICU for cardiac
tamponade and closed a day later. The patient did well
postoperatively, but developed an aortic root aneurysm with some
dehiscence of the proximal suture line and further progression
of aortic root dilatation. In the meantime the patient was seen
by Dr. [**First Name (STitle) **] over at [**Hospital3 1810**] for workup for possible
Marfan syndrome. The patient does in fact have Marfan syndrome
diagnosed by gene analysis. She now presents for surgical
management.

MEDICAL HISTORY: - Mechanical MVR [**2153**] (29mm Carbomedics) secondary to myxomatous
mitral valve disease and a flail mitral leaflet
- Afib/flutter post op s/p successful cardioversion and
amiodarone therapy
- Type A aortic dissection s/p repair on [**2164-4-2**] complicated by
bleeding and afib
- Residual Type B aortic dissection from aortic arch down to
aortic bifurcation
- HTN
- Possible Connective Tissue Disease being investigated by Dr.
[**First Name (STitle) **] at [**Hospital3 1810**]
- Seasonal Allergies
- DJD with chronic LBP
- h/o spontaneous PTX [**2139**]
- C section in [**2151**]
.
ALLERGIES:
Penicillin, Ampicillin--rash
Erythromycin--nausea
.
[**Hospital1 18**] cardiologist: [**First Name8 (NamePattern2) **] [**Doctor Last Name **]
PCP: [**Last Name (NamePattern4) **]. [**Last Name (STitle) 14720**]
[**Name (STitle) **] cardiologist: Dr. [**Last Name (STitle) 14715**]

MEDICATION ON ADMISSION: MVI, coumadin 5', losartan 50', aspirin 81', lopressor 100'',
zyrtec 10', keflex 500'''', zocor

ALLERGIES: Penicillins / Erythromycin Base

PHYSICAL EXAM: 80 sr  115/70
GEN: NAD
SKIN: Unremarkable
HEENT: Unremarkable
NECK: Supple, FROM, No JVD
LUNGS: CTA
HEART: RRR, + Click, well healed sternotomy
ABD: Soft, NT/ND, NABS
EXT: Warm, well perfused, 2+ pulses. No varicosities
NEURO: Nonfocal

FAMILY HISTORY: There is a family h/o valvular disease in her mother (had MVR in
[**2159**]). Brother died of CHF at 47yo. Father died of MI and CVA.
She is of Filipino heritage.

SOCIAL HISTORY: Social history is significant for the absence of current or
former tobacco use. There is no history of alcohol abuse. She
lives with her husband and 13 year old daughter. She works as a
controller for an advertisement agency in [**Location (un) 3844**].
Dissection of aorta, thoracic,Marfan syndrome,Urinary tract infection, site not specified,Aortic valve disorders,Atrial fibrillation,Degeneration of lumbar or lumbosacral intervertebral disc,Unspecified essential hypertension,Heart valve replaced by other means
Dsct of thoracic aorta,Marfan syndrome,Urin tract infection NOS,Aortic valve disorder,Atrial fibrillation,Lumb/lumbosac disc degen,Hypertension NOS,Heart valve replac NEC
Admission Date:  [**2165-11-18**]              Discharge Date:   [**2165-11-26**]

Date of Birth:  [**2118-11-10**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Penicillins / Erythromycin Base

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Dilated aortic root

Major Surgical or Invasive Procedure:
[**2165-11-21**] - Redo Sternotomy, Bentall procdure (25mm St. [**First Name5 (NamePattern1) 923**] [**Last Name (NamePattern1) 14723**]
Masters Mechanical graft valve composite)


History of Present Illness:
The patient is a 46-year-old woman who 11 years ago underwent a
mitral valve replacement with a mechanical prosthesis.
Approximately a year-and-a-half ago she presented with an acute
type A aortic dissection. The patient underwent
Dacron tube graft replacement of her ascending aorta from the
sinotubular junction to the mid aortic arch. The patient was
coagulopathic and needed to be reopened in the ICU for cardiac
tamponade and closed a day later. The patient did well
postoperatively, but developed an aortic root aneurysm with some
dehiscence of the proximal suture line and further progression
of aortic root dilatation. In the meantime the patient was seen
by Dr. [**First Name (STitle) **] over at [**Hospital3 1810**] for workup for possible
Marfan syndrome. The patient does in fact have Marfan syndrome
diagnosed by gene analysis. She now presents for surgical
management.

Past Medical History:
- Mechanical MVR [**2153**] (29mm Carbomedics) secondary to myxomatous
mitral valve disease and a flail mitral leaflet
- Afib/flutter post op s/p successful cardioversion and
amiodarone therapy
- Type A aortic dissection s/p repair on [**2164-4-2**] complicated by
bleeding and afib
- Residual Type B aortic dissection from aortic arch down to
aortic bifurcation
- HTN
- Possible Connective Tissue Disease being investigated by Dr.
[**First Name (STitle) **] at [**Hospital3 1810**]
- Seasonal Allergies
- DJD with chronic LBP
- h/o spontaneous PTX [**2139**]
- C section in [**2151**]
.
ALLERGIES:
Penicillin, Ampicillin--rash
Erythromycin--nausea
.
[**Hospital1 18**] cardiologist: [**First Name8 (NamePattern2) **] [**Doctor Last Name **]
PCP: [**Last Name (NamePattern4) **]. [**Last Name (STitle) 14720**]
[**Name (STitle) **] cardiologist: Dr. [**Last Name (STitle) 14715**]

Social History:
Social history is significant for the absence of current or
former tobacco use. There is no history of alcohol abuse. She
lives with her husband and 13 year old daughter. She works as a
controller for an advertisement agency in [**Location (un) 3844**].


Family History:
There is a family h/o valvular disease in her mother (had MVR in
[**2159**]). Brother died of CHF at 47yo. Father died of MI and CVA.
She is of Filipino heritage.

Physical Exam:
80 sr  115/70
GEN: NAD
SKIN: Unremarkable
HEENT: Unremarkable
NECK: Supple, FROM, No JVD
LUNGS: CTA
HEART: RRR, + Click, well healed sternotomy
ABD: Soft, NT/ND, NABS
EXT: Warm, well perfused, 2+ pulses. No varicosities
NEURO: Nonfocal

Pertinent Results:
[**2165-11-18**] 07:05PM   PT-14.9* PTT-25.2 INR(PT)-1.3*
[**2165-11-18**] 07:05PM   WBC-5.7 RBC-3.72* HGB-11.1* HCT-32.6* MCV-88
MCH-29.9 MCHC-34.1 RDW-13.2
[**2165-11-18**] 07:05PM   ALT(SGPT)-21 AST(SGOT)-29 ALK PHOS-68
AMYLASE-186* TOT BILI-0.5
[**2165-11-18**] 07:05PM   GLUCOSE-162* UREA N-25* CREAT-0.7 SODIUM-140
POTASSIUM-3.8 CHLORIDE-102 TOTAL CO2-27 ANION GAP-15

[**2165-11-21**] ECHO
1. Very poor image quality. Limited study.
2. Regional left ventricular wall motion is normal. There is
mild global left ventricular hypokinesis (LVEF = 40%). Overall
left ventricular systolic function is mildly depressed (LVEF= 40
%).
3.Right ventricular chamber size and free wall motion are
normal.
4.The aortic root is moderately dilated at the sinus level. A
mobile density is seen in the descending aorta consistent with
an intimal flap/aortic dissection (old dissection).
5. There are three aortic valve leaflets. Mild to moderate
([**12-18**]+) aortic regurgitation is seen.
6. A mechanical mitral valve prosthesis is present. Unable to
fully evaluate it due to shadowing and poor image quality.

Post bypass

1. Patient is in sinus rhythm and receiving an infusion of
epinephrine.
2. Biventricular systolic function is unchanged.
3. No good views of the aortic valve for assessment. Surgeon
aware.



Brief Hospital Course:
Mrs. [**Known lastname 14719**] was admitted to the [**Hospital1 18**] on [**2165-11-18**] for surgical
management of her dilated aorta. She was started on heparin as
she had stopped her coumadin in preparation for surgery. She was
worked-up in the usual preoperative manner. Ciprofloxacin was
started for a urinary tract infection. On [**2165-11-21**], Mrs. [**Known lastname 14719**]
was taken to the operating room where she underwent a redo
sternotomy with a bentall procedure using a 25mm St. [**Male First Name (un) 923**]
composite graft. Postoperatively she was taken to the cardiac
surgical intensive care unit for monitoring. On postoperative
day one, Mrs. [**Known lastname 14719**] awoke neurologically intact and was
extubated. Coumadin was resumed for her mechanical valves. On
postoperative day two, she was transferred to the step down unit
for further recovery. She was gently diuresed towards her
preoperative weight. The physical therapy service was consulted
for assistance with her postoperative strength and mobility.
Heparin was started as her INR was slow to reach a therapeutic
level. Her INR was therapeutic and she was ready for discharge
home on POD # 5.

Medications on Admission:
MVI, coumadin 5', losartan 50', aspirin 81', lopressor 100'',
zyrtec 10', keflex 500'''', zocor

Discharge Medications:
1. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
Disp:*60 Capsule(s)* Refills:*0*
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*90 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
4. Warfarin 1 mg Tablet Sig: As instructed by Dr. [**Last Name (STitle) 14715**]
Tablet PO DAILY (Daily) as needed for AVR mech : 5 mg
alternating with 2.5 mg, as prior to surgery.
Goal INR is 3.0-3.5. Take as instructed by Dr. [**Last Name (STitle) 14715**].
Phone([**Telephone/Fax (1) 14724**] .
Disp:*50 Tablet(s)* Refills:*1*
5. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID
(2 times a day).
Disp:*180 Tablet(s)* Refills:*0*
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO once a day.


Discharge Disposition:
Home With Service

Facility:
Maxim Health

Discharge Diagnosis:
Type A dissection with dilated aortic root
HTN
DJD
AI
Spontaneous pneumothorax
AF in past
MVR (Mechanical) [**2153**]
Type A Dissection Repair [**3-22**]


Discharge Condition:
Good.


Discharge Instructions:
1) Monitor wounds for signs of infection. These include rednessm
drainage or increasing pain. Please contact your surgeons office
at ([**Telephone/Fax (1) 1504**] with any wound issues.
2) Report any fever greater then 100.5.
3) Report any weight gain of 2 pounds in 24 hours or 5 pounds in
1 week. Weigh yourself daily.
4) You may shower and wash your incision with soap. No lotions,
creams or powders to incision until it has healed. Use sunscreen
on scar when exposed to prolonged periods of sunlight.
5) No driving for 1 month or while on narcotics. No lifting
greater then 10 pounds for 10 weeks from date of surgery.
6) Take lasix for 10 days then stop. Take with potassium.
7) Take coumadin as instructed for a goal INR 3.0-3.5. Dr.
[**Last Name (STitle) 14715**] will manage you coumadin dosing as an outpatient.
Phone([**Telephone/Fax (1) 14724**]. The visting nurse may draw your blood work
and send results to Dr. [**Last Name (STitle) 14715**] at Fax-([**Telephone/Fax (1) 14725**]
phone-([**Telephone/Fax (1) 14724**].
8) Losartan should be resumed at some point as an outpatient by
Dr. [**Last Name (STitle) 14726**].
9) Please call with any questions or concerns.

Followup Instructions:
Follow-up with Dr. [**Last Name (STitle) 914**] in 1 month. ([**Telephone/Fax (1) 1504**]
Follow-up with Dr. [**Last Name (STitle) 14715**] ([**Telephone/Fax (1) 14724**] in [**12-18**] weeks for
routine postoperative follow-up and immediately upon discharge
for coumadin dosing.
Follow-up with Dr. [**Last Name (STitle) 14720**] in 2 weeks. [**Telephone/Fax (1) 14721**]
Please call all providers for appointments.

**** Dr. [**Last Name (STitle) 14715**] will manage your coumadin dosing as an
outpatient. Blood work may be performed by the visiting nurse
with results of your blood work (PT/INR) sent to Dr.
[**Last Name (STitle) 14715**] at Fax ([**Telephone/Fax (1) 14725**] Phone ([**Telephone/Fax (1) 14724**]. You
goal INR is 3.0-3.5.



Completed by:[**2165-11-26**]
{'Dissection of aorta, thoracic,Marfan syndrome,Urinary tract infection, site not specified,Aortic valve disorders,Atrial fibrillation,Degeneration of lumbar or lumbosacral intervertebral disc,Unspecified essential hypertension,Heart valve replaced by other means'}


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: Dilated aortic root

PRESENT ILLNESS: The patient is a 46-year-old woman who 11 years ago underwent a
mitral valve replacement with a mechanical prosthesis.
Approximately a year-and-a-half ago she presented with an acute
type A aortic dissection. The patient underwent
Dacron tube graft replacement of her ascending aorta from the
sinotubular junction to the mid aortic arch. The patient was
coagulopathic and needed to be reopened in the ICU for cardiac
tamponade and closed a day later. The patient did well
postoperatively, but developed an aortic root aneurysm with some
dehiscence of the proximal suture line and further progression
of aortic root dilatation. In the meantime the patient was seen
by Dr. [**First Name (STitle) **] over at [**Hospital3 1810**] for workup for possible
Marfan syndrome. The patient does in fact have Marfan syndrome
diagnosed by gene analysis. She now presents for surgical
management.

MEDICAL HISTORY: - Mechanical MVR [**2153**] (29mm Carbomedics) secondary to myxomatous
mitral valve disease and a flail mitral leaflet
- Afib/flutter post op s/p successful cardioversion and
amiodarone therapy
- Type A aortic dissection s/p repair on [**2164-4-2**] complicated by
bleeding and afib
- Residual Type B aortic dissection from aortic arch down to
aortic bifurcation
- HTN
- Possible Connective Tissue Disease being investigated by Dr.
[**First Name (STitle) **] at [**Hospital3 1810**]
- Seasonal Allergies
- DJD with chronic LBP
- h/o spontaneous PTX [**2139**]
- C section in [**2151**]
.
ALLERGIES:
Penicillin, Ampicillin--rash
Erythromycin--nausea
.
[**Hospital1 18**] cardiologist: [**First Name8 (NamePattern2) **] [**Doctor Last Name **]
PCP: [**Last Name (NamePattern4) **]. [**Last Name (STitle) 14720**]
[**Name (STitle) **] cardiologist: Dr. [**Last Name (STitle) 14715**]

MEDICATION ON ADMISSION: MVI, coumadin 5', losartan 50', aspirin 81', lopressor 100'',
zyrtec 10', keflex 500'''', zocor

ALLERGIES: Penicillins / Erythromycin Base

PHYSICAL EXAM: 80 sr  115/70
GEN: NAD
SKIN: Unremarkable
HEENT: Unremarkable
NECK: Supple, FROM, No JVD
LUNGS: CTA
HEART: RRR, + Click, well healed sternotomy
ABD: Soft, NT/ND, NABS
EXT: Warm, well perfused, 2+ pulses. No varicosities
NEURO: Nonfocal

FAMILY HISTORY: There is a family h/o valvular disease in her mother (had MVR in
[**2159**]). Brother died of CHF at 47yo. Father died of MI and CVA.
She is of Filipino heritage.

SOCIAL HISTORY: Social history is significant for the absence of current or
former tobacco use. There is no history of alcohol abuse. She
lives with her husband and 13 year old daughter. She works as a
controller for an advertisement agency in [**Location (un) 3844**]. 

### Response:
{'Dissection of aorta, thoracic,Marfan syndrome,Urinary tract infection, site not specified,Aortic valve disorders,Atrial fibrillation,Degeneration of lumbar or lumbosacral intervertebral disc,Unspecified essential hypertension,Heart valve replaced by other means'}
