CHIEF COMPLAINT: 1. Ascending aortic aneurysm and bicuspid aortic valve.
2. Severe aortic insufficiency as well as aortic stenosis.

PRESENT ILLNESS: This is a 62-year-old male who had
been evaluated approximately 4 years ago for new onset of
chest pain and  upon that workup, it was noted the patient
had a dilated ascending aorta and some aortic stenosis.
Several followup echocardiograms were performed during this 4-
year period. Now presents with increase in aortic size up to
5 cm as well as significant aortic stenosis with [**First Name8 (NamePattern2) **] [**Location (un) 109**] of
0.7 and a peak gradient of 95. His  ejection fraction was
60%. He also underwent a CAT scan preoperatively which showed
once again ascending aorta of approximately 4.9-5 cm. Based
on these findings, the patient was recommended to undergo
aortic valve replacement as well as ascending aortic
replacement. The patient understood the risks and benefits of
the procedure which included but were not limited to
bleeding, infection, myocardial infarction, stroke, death,
renal and pulmonary insufficiency as well as the possibility
of blood transfusions and future revascularization
procedures. In spite of this, the patient agreed to proceed.

MEDICAL HISTORY: PMH: AS [**12-21**] bicuspid valve, hyperlipidemia, migraines, GERD,
OSA, sig alcohol history
PSH: anppy, tonsillectomy, schatzki ring dilation, colon
polypectomy

MEDICATION ON ADMISSION: [**Last Name (un) 1724**]: zocor 60', aspirin 81'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On physical examination, his pulse was 72 and respirations were
14. Blood pressure was 126/74.  His height was 71" and he
weighed 190 lbs.  Overall, he appeared to be a well developed
and well-nourished male in no acute distress.  His skin was
warm, dry, and intact.  His extraocular movements were intact.
His pupils were equal, round, and react to light.  His neck was
supple with full range of motion without any JVD.  There were no
carotid bruits noted.  His lungs were clear to auscultation.
Sternal Incision is clean, dry and inatct. Cardiac examination
revealed regular rate and rhythm His abdomen was soft,
nontender, and nondistended with positive bowel sounds.
Extremities are warm and well perfused without any edema or
varicosities. Neurologically, he was alert and oriented x3.
Moving all extremities and nonfocal examination.

FAMILY HISTORY: FH: Father had either an MI or stroke in his early 60??????s.
Paternal
grandfather died of cardiac disease at age 62

SOCIAL HISTORY: SOCIAL HISTORY:  () Single   (+) Married   () Divorced
Has two children.
Lives with: wife in [**Name (NI) 86**]
Occupation: [**Name (NI) 75297**]. Currently doing consulting
ETOH: Several alcoholic drinks a day
Contact person upon discharge: [**Name (NI) **] [**Name (NI) **] (wife):
[**Telephone/Fax (1) 77243**]
Thoracic aneurysm without mention of rupture,Congenital insufficiency of aortic valve,Aortic valve disorders,Urinary complications, not elsewhere classified,Esophageal reflux,Other and unspecified hyperlipidemia,Oliguria and anuria,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
Thoracic aortic aneurysm,Cong aorta valv insuffic,Aortic valve disorder,Surg compl-urinary tract,Esophageal reflux,Hyperlipidemia NEC/NOS,Oliguria & anuria,Abn react-anastom/graft
Admission Date:  [**2200-3-20**]              Discharge Date:   [**2200-3-23**]

Date of Birth:  [**2137-11-25**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
1. Ascending aortic aneurysm and bicuspid aortic valve.
2. Severe aortic insufficiency as well as aortic stenosis.


Major Surgical or Invasive Procedure:
AVR (27mm mosaic), Asc Aorta replacement


History of Present Illness:
This is a 62-year-old male who had
been evaluated approximately 4 years ago for new onset of
chest pain and  upon that workup, it was noted the patient
had a dilated ascending aorta and some aortic stenosis.
Several followup echocardiograms were performed during this 4-
year period. Now presents with increase in aortic size up to
5 cm as well as significant aortic stenosis with [**First Name8 (NamePattern2) **] [**Location (un) 109**] of
0.7 and a peak gradient of 95. His  ejection fraction was
60%. He also underwent a CAT scan preoperatively which showed
once again ascending aorta of approximately 4.9-5 cm. Based
on these findings, the patient was recommended to undergo
aortic valve replacement as well as ascending aortic
replacement. The patient understood the risks and benefits of
the procedure which included but were not limited to
bleeding, infection, myocardial infarction, stroke, death,
renal and pulmonary insufficiency as well as the possibility
of blood transfusions and future revascularization
procedures. In spite of this, the patient agreed to proceed.

Past Medical History:
PMH: AS [**12-21**] bicuspid valve, hyperlipidemia, migraines, GERD,
OSA, sig alcohol history
PSH: anppy, tonsillectomy, schatzki ring dilation, colon
polypectomy


Social History:
SOCIAL HISTORY:  () Single   (+) Married   () Divorced
Has two children.
Lives with: wife in [**Name (NI) 86**]
Occupation: [**Name (NI) 75297**]. Currently doing consulting
ETOH: Several alcoholic drinks a day
Contact person upon discharge: [**Name (NI) **] [**Name (NI) **] (wife):
[**Telephone/Fax (1) 77243**]

Family History:
FH: Father had either an MI or stroke in his early 60??????s.
Paternal
grandfather died of cardiac disease at age 62

Physical Exam:
On physical examination, his pulse was 72 and respirations were
14. Blood pressure was 126/74.  His height was 71" and he
weighed 190 lbs.  Overall, he appeared to be a well developed
and well-nourished male in no acute distress.  His skin was
warm, dry, and intact.  His extraocular movements were intact.
His pupils were equal, round, and react to light.  His neck was
supple with full range of motion without any JVD.  There were no
carotid bruits noted.  His lungs were clear to auscultation.
Sternal Incision is clean, dry and inatct. Cardiac examination
revealed regular rate and rhythm His abdomen was soft,
nontender, and nondistended with positive bowel sounds.
Extremities are warm and well perfused without any edema or
varicosities. Neurologically, he was alert and oriented x3.
Moving all extremities and nonfocal examination.


Pertinent Results:
[**2200-3-22**] 08:17AM BLOOD

WBC-10.1 RBC-2.99* Hgb-9.7* Hct-27.0* MCV-91 MCH-32.4*
MCHC-35.8* RDW-13.4 Plt Ct-106*

[**2200-3-22**] 08:17AM BLOOD

Plt Ct-106*

[**2200-3-21**] 01:54AM BLOOD

PT-13.4 PTT-41.1* INR(PT)-1.2*

[**2200-3-22**] 08:17AM BLOOD

Glucose-108* UreaN-15 Creat-0.8 Na-134 K-4.1 Cl-101 HCO3-26
AnGap-11

[**2200-3-21**] 09:00AM

freeCa-1.04*

[**2200-3-20**] 07:40AM BLOOD

Hgb-14.3 calcHCT-43

[**2200-3-22**] 1:37 PM

CHEST (PORTABLE AP)

Tubes and lines have been removed. Aside from linear basal left
lower atelectasis the lungs are clear. Cardiac size is top
normal, accentuated by the projection. There is no pneumothorax
or sizable pleural effusion. Fluid overload has resolved.
Mediastinal wires are aligned.

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

Results  Measurements  Normal Range
Left Ventricle - Septal Wall Thickness:  *1.3 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  *1.2 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  5.1 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  60% to 65%  >= 55%
Aorta - Annulus:  2.8 cm  <= 3.0 cm
Aorta - Sinus Level:  *4.1 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  *3.4 cm  <= 3.0 cm
Aorta - Ascending:  *4.6 cm  <= 3.4 cm
Aorta - Descending Thoracic:  2.3 cm  <= 2.5 cm
Aortic Valve - Peak Velocity:  *2.9 m/sec  <= 2.0 m/sec
Aortic Valve - Peak Gradient:  *33 mm Hg  < 20 mm Hg
Aortic Valve - Mean Gradient:  18 mm Hg
Aortic Valve - LVOT pk vel:  1.39 m/sec
Aortic Valve - LVOT diam:  2.5 cm
Aortic Valve - Valve Area:  *1.0 cm2  >= 3.0 cm2

Findings
LEFT ATRIUM: Normal LA size.

RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is
seen in the RA and extending into the RV. Normal interatrial
septum. No ASD by 2D or color Doppler.

LEFT VENTRICLE: Mild symmetric LVH. Normal LV cavity size.
Overall normal LVEF (>55%).

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Moderately dilated aortic sinus. Moderately dilated
ascending aorta. Normal descending aorta diameter.

AORTIC VALVE: Bicuspid aortic valve. Moderate AS (AoVA
1.0-1.2cm2) Significant AR, but cannot be quantified. Eccentric
AR jet directed toward the anterior mitral leaflet.

MITRAL VALVE: Normal mitral valve leaflets with trivial MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: PVR not well seen. Physiologic
(normal) PR. No Doppler evidence for PDA

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. The patient was under general anesthesia throughout
the procedure. No TEE related complications. The patient appears
to be in sinus rhythm. Results were personally reviewed with the
MD caring for the patient. See Conclusions for post-bypass data
The post-bypass study was performed while the patient was
receiving vasoactive infusions (see Conclusions for listing of
medications).
Conclusions

PRE-BYPASS:
1. The left atrium is normal in size.
2. No atrial septal defect is seen by 2D or color Doppler.
3. There is mild symmetric left ventricular hypertrophy. The
left ventricular cavity size is normal. Overall left ventricular
systolic function is normal (LVEF>55%).
4. Right ventricular chamber size and free wall motion are
normal.
5. The aortic root is moderately dilated at the sinus level. The
ascending aorta is moderately dilated.
6. The aortic valve is bicuspid. There is moderate aortic valve
stenosis (area 1.0-1.2cm2). Significant aortic regurgitation is
present, but cannot be quantified. The aortic regurgitation jet
is eccentric, directed toward the anterior mitral leaflet.
7. The mitral valve appears structurally normal with trivial
mitral regurgitation.
8. The pulmonic valve prosthesis is not well seen.
9. There is no pericardial effusion.

POST-BYPASS:

For the post-bypass study, the patient was receiving vasoactive
infusions including phenylephrine and was in SR.
1. A well-seated bioprosthetic valve is seen in the aortic
position with normal leaflet motion and gradients (mean gradient
= 10 mmHg) with a cardiac output of 6L/min. Trivial aortic
regurgitation is seen.
2. Regional and global left ventricular systolic function are
normal.
3. Aortic contours are intact post-decannulation.


Brief Hospital Course:
[**3-20**]

PROCEDURE PERFORMED:
1. Ascending aortic replacement with a number 26 Gelweave graft.
2. Aortic valve replacement with a #27 Mosaic porcine valve.

No complications. tolerated the proceure well. Transfered to the
CVICU in stable condition.

Extubated POD # 1 / diureses throughout the hospital course / to
be continued on DC.

Foley DC - pt urinating on DC. Diet advanced. Tolerating PO's

CT out POD # 2, post cxr no sequele from chest tubes

Pacing wires out POD # 3. No sequele

PT consult

Cleared for home with VNA


Medications on Admission:
[**Last Name (un) 1724**]: zocor 60', aspirin 81'

Discharge Medications:
1. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours)
for 7 days.
Disp:*14 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
4. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
5. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
Disp:*30 Suppository(s)* Refills:*0*
6. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed.
Disp:*30 Tablet(s)* Refills:*0*
7. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 7
days.
Disp:*14 Tablet(s)* Refills:*0*
8. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
9. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
10. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*6*


Discharge Disposition:
Home With Service

Facility:
tba

Discharge Diagnosis:
PREOPERATIVE DIAGNOSIS:
1. Constrictive pericarditis.
2. Severe two-vessel coronary artery disease.
3. Status post previous myocardial infarction.


Discharge Condition:
Good


Discharge Instructions:
no creams, lotions or powders to any incisions
no lifting > 10# for 10 weeks
shower daily, no swimming or bathing for 1 month
no driving for 1 month


Followup Instructions:
PCP: [**Name10 (NameIs) 8505**],[**Name11 (NameIs) **] [**Name Initial (NameIs) **] [**Telephone/Fax (1) 8506**] - call and make an
appointmnent upon leavig the hospital. You should see your PCP
in one week.

Call Dr [**Last Name (STitle) 35849**] office and schedule an appointment for 2 weeks



Completed by:[**2200-3-23**]
{'Thoracic aneurysm without mention of rupture,Congenital insufficiency of aortic valve,Aortic valve disorders,Urinary complications, not elsewhere classified,Esophageal reflux,Other and unspecified hyperlipidemia,Oliguria and anuria,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'}


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: 1. Ascending aortic aneurysm and bicuspid aortic valve.
2. Severe aortic insufficiency as well as aortic stenosis.

PRESENT ILLNESS: This is a 62-year-old male who had
been evaluated approximately 4 years ago for new onset of
chest pain and  upon that workup, it was noted the patient
had a dilated ascending aorta and some aortic stenosis.
Several followup echocardiograms were performed during this 4-
year period. Now presents with increase in aortic size up to
5 cm as well as significant aortic stenosis with [**First Name8 (NamePattern2) **] [**Location (un) 109**] of
0.7 and a peak gradient of 95. His  ejection fraction was
60%. He also underwent a CAT scan preoperatively which showed
once again ascending aorta of approximately 4.9-5 cm. Based
on these findings, the patient was recommended to undergo
aortic valve replacement as well as ascending aortic
replacement. The patient understood the risks and benefits of
the procedure which included but were not limited to
bleeding, infection, myocardial infarction, stroke, death,
renal and pulmonary insufficiency as well as the possibility
of blood transfusions and future revascularization
procedures. In spite of this, the patient agreed to proceed.

MEDICAL HISTORY: PMH: AS [**12-21**] bicuspid valve, hyperlipidemia, migraines, GERD,
OSA, sig alcohol history
PSH: anppy, tonsillectomy, schatzki ring dilation, colon
polypectomy

MEDICATION ON ADMISSION: [**Last Name (un) 1724**]: zocor 60', aspirin 81'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On physical examination, his pulse was 72 and respirations were
14. Blood pressure was 126/74.  His height was 71" and he
weighed 190 lbs.  Overall, he appeared to be a well developed
and well-nourished male in no acute distress.  His skin was
warm, dry, and intact.  His extraocular movements were intact.
His pupils were equal, round, and react to light.  His neck was
supple with full range of motion without any JVD.  There were no
carotid bruits noted.  His lungs were clear to auscultation.
Sternal Incision is clean, dry and inatct. Cardiac examination
revealed regular rate and rhythm His abdomen was soft,
nontender, and nondistended with positive bowel sounds.
Extremities are warm and well perfused without any edema or
varicosities. Neurologically, he was alert and oriented x3.
Moving all extremities and nonfocal examination.

FAMILY HISTORY: FH: Father had either an MI or stroke in his early 60??????s.
Paternal
grandfather died of cardiac disease at age 62

SOCIAL HISTORY: SOCIAL HISTORY:  () Single   (+) Married   () Divorced
Has two children.
Lives with: wife in [**Name (NI) 86**]
Occupation: [**Name (NI) 75297**]. Currently doing consulting
ETOH: Several alcoholic drinks a day
Contact person upon discharge: [**Name (NI) **] [**Name (NI) **] (wife):
[**Telephone/Fax (1) 77243**] 

### Response:
{'Thoracic aneurysm without mention of rupture,Congenital insufficiency of aortic valve,Aortic valve disorders,Urinary complications, not elsewhere classified,Esophageal reflux,Other and unspecified hyperlipidemia,Oliguria and anuria,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'}
