FHIR IG analytics| Package | de.medizininformatikinitiative.kerndatensatz.seltene |
| Resource Type | Bundle |
| Id | Bundle-bundle-marfan-complete.json |
| FHIR Version | R4 |
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No resources found
No narrative content found in resource
FHIR
FHIRsmith{
"resourceType": "Bundle",
"id": "bundle-marfan-complete",
"type": "transaction",
"timestamp": "2024-12-15T14:00:00+00:00",
"entry": [
{
"fullUrl": "urn:uuid:546740dd-771d-41e4-a2a5-e8d6a2b5c505",
"resource": {
"resourceType": "Patient",
"id": "patient-marfan-001",
"identifier": [
{
"system": "https://www.medizininformatik-initiative.de/fhir/sid/patient-id",
"value": "MRF-2024-001"
}
],
"gender": "male",
"birthDate": "2005-01-01"
},
"request": {
"method": "POST",
"url": "Patient"
}
},
{
"fullUrl": "urn:uuid:12b18efe-aae8-4039-9e2c-466ee0cb0ce0",
"resource": {
"resourceType": "Condition",
"id": "condition-marfan-suspected",
"meta": {
"profile": [
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]
},
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/condition-assertedDate",
"valueDateTime": "2024-12-10"
}
],
"clinicalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active"
}
]
},
"verificationStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "provisional"
}
]
},
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis"
}
]
}
],
"code": {
"coding": [
{
"system": "http://fhir.de/CodeSystem/bfarm/icd-10-gm",
"version": "2024",
"code": "Q87.4",
"display": "Marfan-Syndrom"
},
{
"system": "http://snomed.info/sct",
"code": "19346006",
"display": "Marfan syndrome"
},
{
"system": "http://www.orpha.net",
"code": "558",
"display": "Marfan syndrome"
}
],
"text": "Verdacht auf Marfan-Syndrom"
},
"subject": {
"reference": "Patient/patient-marfan-001"
},
"recordedDate": "2024-12-10",
"note": [
{
"text": "Verdacht auf Marfan-Syndrom aufgrund klinischer Präsentation"
}
]
},
"request": {
"method": "POST",
"url": "Condition"
}
},
{
"fullUrl": "urn:uuid:6842a03b-9adc-4cb7-9126-85d317203e7b",
"resource": {
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"id": "condition-marfan-clinical",
"meta": {
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},
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/condition-assertedDate",
"valueDateTime": "2024-12-15"
}
],
"clinicalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active"
}
]
},
"verificationStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
}
]
},
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis"
}
]
}
],
"code": {
"coding": [
{
"system": "http://omim.org",
"version": "2024",
"code": "154700",
"display": "Marfan syndrome"
},
{
"system": "http://snomed.info/sct",
"code": "19346006",
"display": "Marfan syndrome"
},
{
"system": "http://www.orpha.net",
"code": "558",
"display": "Marfan syndrome"
}
],
"text": "Marfan-Syndrom"
},
"subject": {
"reference": "Patient/patient-marfan-001"
},
"encounter": {
"reference": "Encounter/encounter-cardiology"
},
"recordedDate": "2024-12-15",
"evidence": [
{
"code": [
{
"coding": [
{
"system": "http://human-phenotype-ontology.org",
"code": "HP:0002616",
"display": "Aortic root aneurysm"
}
]
}
],
"detail": [
{
"reference": "Observation/symptom-aortic-root"
}
]
},
{
"code": [
{
"coding": [
{
"system": "http://human-phenotype-ontology.org",
"code": "HP:0001659",
"display": "Aortic regurgitation"
}
]
}
],
"detail": [
{
"reference": "Observation/symptom-aortic-regurg"
}
]
},
{
"code": [
{
"coding": [
{
"system": "http://human-phenotype-ontology.org",
"code": "HP:0001653",
"display": "Mitral regurgitation"
}
]
}
],
"detail": [
{
"reference": "Observation/symptom-mitral-regurg"
}
]
},
{
"code": [
{
"coding": [
{
"system": "http://human-phenotype-ontology.org",
"code": "HP:0000098",
"display": "Tall stature"
}
]
}
],
"detail": [
{
"reference": "Observation/observation-height-001"
}
]
},
{
"code": [
{
"coding": [
{
"system": "http://human-phenotype-ontology.org",
"code": "HP:0100559",
"display": "Lower limb asymmetry"
}
]
}
],
"detail": [
{
"reference": "Observation/observation-leg-asymmetry"
}
]
},
{
"code": [
{
"coding": [
{
"system": "http://human-phenotype-ontology.org",
"code": "HP:0100749",
"display": "Chest pain"
}
]
}
],
"detail": [
{
"reference": "Observation/symptom-chest-pain"
}
]
}
],
"note": [
{
"text": "Marfan-Syndrom klinisch diagnostiziert basierend auf kardialen Befunden, Skelettmerkmalen und ophthalmologischer Manifestation"
}
]
},
"request": {
"method": "POST",
"url": "Condition"
}
},
{
"fullUrl": "urn:uuid:23bd27f8-f2b5-4bc9-8fa3-078c26bc64a2",
"resource": {
"resourceType": "Condition",
"id": "condition-marfan-genetic",
"meta": {
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},
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/condition-assertedDate",
"valueDateTime": "2024-12-20"
}
],
"clinicalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active"
}
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},
"verificationStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
}
]
},
"category": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "782964007",
"display": "Genetic disease"
}
]
}
],
"code": {
"coding": [
{
"system": "http://omim.org",
"version": "2024",
"code": "154700",
"display": "Marfan syndrome"
},
{
"system": "http://snomed.info/sct",
"code": "19346006",
"display": "Marfan syndrome"
},
{
"system": "http://www.orpha.net",
"code": "558",
"display": "Marfan syndrome"
}
],
"text": "Marfan-Syndrom - genetisch bestätigt"
},
"subject": {
"reference": "Patient/patient-marfan-001"
},
"recordedDate": "2024-12-20",
"evidence": [
{
"code": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "106221001",
"display": "Genetic finding"
}
]
}
],
"detail": [
{
"reference": "Observation/variant-fbn1-001"
}
]
}
],
"note": [
{
"text": "FBN1-Mutation c.3217G>A (p.Gly1073Arg) nachgewiesen, krankheitsursächlich. Genetische Diagnose existiert parallel zur klinischen Diagnose."
}
]
},
"request": {
"method": "POST",
"url": "Condition"
}
},
{
"fullUrl": "urn:uuid:f584ef12-6225-4e71-9186-68528f68e07d",
"resource": {
"resourceType": "Condition",
"id": "condition-cataract",
"meta": {
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},
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/condition-assertedDate",
"valueDateTime": "2024-10-15"
}
],
"clinicalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "resolved"
}
]
},
"verificationStatus": {
"coding": [
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"code": "confirmed"
}
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},
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis"
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]
}
],
"code": {
"coding": [
{
"system": "http://fhir.de/CodeSystem/bfarm/icd-10-gm",
"version": "2024",
"code": "H26.9",
"display": "Katarakt, nicht näher bezeichnet"
},
{
"system": "http://snomed.info/sct",
"code": "193570009",
"display": "Cataract"
},
{
"system": "http://human-phenotype-ontology.org",
"code": "HP:0000518",
"display": "Cataract"
}
],
"text": "Katarakt bilateral"
},
"subject": {
"reference": "Patient/patient-marfan-001"
},
"encounter": {
"reference": "Encounter/encounter-ophthalmology"
},
"abatementDateTime": "2024-11-12",
"recordedDate": "2024-10-15",
"evidence": [
{
"code": [
{
"coding": [
{
"system": "http://human-phenotype-ontology.org",
"code": "HP:0000518",
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}
]
}
],
"detail": [
{
"reference": "Observation/symptom-cataract"
}
]
}
],
"note": [
{
"text": "Katarakt bilateral, operativ versorgt"
}
]
},
"request": {
"method": "POST",
"url": "Condition"
}
},
{
"fullUrl": "urn:uuid:72fa4681-014d-4caa-86a3-97cea92766f4",
"resource": {
"resourceType": "Observation",
"id": "observation-height-001",
"status": "final",
"category": [
{
"coding": [
{
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"code": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8302-2",
"display": "Body height"
}
]
},
"subject": {
"reference": "Patient/patient-marfan-001"
},
"effectiveDateTime": "2024-12-15",
"valueQuantity": {
"value": 213,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
},
"interpretation": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation",
"code": "H",
"display": "High"
}
]
}
],
"bodySite": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "38266002",
"display": "Entire body as a whole"
}
]
},
"component": [
{
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"code": "HP:0000098",
"display": "Tall stature"
}
]
},
"valueString": "Pathologischer Hochwuchs >99. Perzentile"
}
]
},
"request": {
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"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:9dfa4ddc-723f-4c65-b86d-1a88304e77fe",
"resource": {
"resourceType": "Observation",
"id": "observation-leg-asymmetry",
"status": "final",
"category": [
{
"coding": [
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"code": "exam"
}
]
}
],
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "707738004",
"display": "Leg length discrepancy"
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]
},
"subject": {
"reference": "Patient/patient-marfan-001"
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"effectiveDateTime": "2024-12-15",
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "7771000",
"display": "Left"
}
]
},
"interpretation": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation",
"code": "A",
"display": "Abnormal"
}
]
}
],
"bodySite": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "30021000",
"display": "Lower leg structure"
}
]
},
"component": [
{
"code": {
"coding": [
{
"system": "http://human-phenotype-ontology.org",
"code": "HP:0100559",
"display": "Lower limb asymmetry"
}
]
},
"valueString": "Rechtes Bein verkürzt"
}
]
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:b5f66545-2f6e-450c-a92e-8e9d2626e003",
"resource": {
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"id": "symptom-chest-pain",
"status": "final",
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"system": "http://human-phenotype-ontology.org",
"code": "HP:0100749",
"display": "Chest pain"
},
{
"system": "http://snomed.info/sct",
"code": "29857009",
"display": "Chest pain"
}
],
"text": "Thoraxschmerzen"
},
"subject": {
"reference": "Patient/patient-marfan-001"
},
"effectiveDateTime": "2024-12-15",
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "52101004",
"display": "Present"
}
]
},
"interpretation": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation",
"code": "A",
"display": "Abnormal"
}
]
}
]
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:ce25223c-45fe-4a87-ba1b-e120cba24e94",
"resource": {
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"id": "symptom-cataract",
"status": "final",
"category": [
{
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"code": "exam"
}
]
}
],
"code": {
"coding": [
{
"system": "http://human-phenotype-ontology.org",
"code": "HP:0000518",
"display": "Cataract"
},
{
"system": "http://snomed.info/sct",
"code": "193570009",
"display": "Cataract"
}
],
"text": "Katarakt bilateral"
},
"subject": {
"reference": "Patient/patient-marfan-001"
},
"effectiveDateTime": "2024-10-15",
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "51440002",
"display": "Bilateral"
}
]
},
"interpretation": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation",
"code": "A",
"display": "Abnormal"
}
]
}
],
"bodySite": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "81745001",
"display": "Eye structure"
}
]
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:a482bf38-9c7a-4295-a0f2-a38c1d15aae7",
"resource": {
"resourceType": "Observation",
"id": "symptom-aortic-root",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "imaging"
}
]
}
],
"code": {
"coding": [
{
"system": "http://human-phenotype-ontology.org",
"code": "HP:0002616",
"display": "Aortic root aneurysm"
},
{
"system": "http://snomed.info/sct",
"code": "251036003",
"display": "Aortic root dilatation"
}
],
"text": "Aortenwurzeldilatation"
},
"subject": {
"reference": "Patient/patient-marfan-001"
},
"effectiveDateTime": "2024-12-15",
"valueQuantity": {
"value": 48,
"unit": "mm",
"system": "http://unitsofmeasure.org",
"code": "mm"
},
"interpretation": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation",
"code": "H",
"display": "High"
}
]
}
],
"referenceRange": [
{
"high": {
"value": 40,
"unit": "mm"
},
"text": "Normwert <40mm"
}
]
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:7b78bb46-817f-4786-84f8-0805b1580192",
"resource": {
"resourceType": "Observation",
"id": "symptom-aortic-regurg",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "imaging"
}
]
}
],
"code": {
"coding": [
{
"system": "http://human-phenotype-ontology.org",
"code": "HP:0001659",
"display": "Aortic regurgitation"
},
{
"system": "http://snomed.info/sct",
"code": "60234000",
"display": "Aortic valve regurgitation"
}
],
"text": "Aortenklappeninsuffizienz"
},
"subject": {
"reference": "Patient/patient-marfan-001"
},
"effectiveDateTime": "2024-12-15",
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "838545002",
"display": "Moderate aortic valve regurgitation"
}
],
"text": "Aortenklappeninsuffizienz Grad II"
},
"interpretation": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation",
"code": "A",
"display": "Abnormal"
}
]
}
]
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:a933aaca-920c-4d29-be34-1d38c60b8bc9",
"resource": {
"resourceType": "Observation",
"id": "symptom-mitral-regurg",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "imaging"
}
]
}
],
"code": {
"coding": [
{
"system": "http://human-phenotype-ontology.org",
"code": "HP:0001653",
"display": "Mitral regurgitation"
},
{
"system": "http://snomed.info/sct",
"code": "48724000",
"display": "Mitral valve regurgitation"
}
],
"text": "Mitralklappeninsuffizienz"
},
"subject": {
"reference": "Patient/patient-marfan-001"
},
"effectiveDateTime": "2024-12-15",
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "838451005",
"display": "Mild mitral valve regurgitation"
}
],
"text": "Mitralklappeninsuffizienz Grad I"
},
"interpretation": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation",
"code": "A",
"display": "Abnormal"
}
]
}
]
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},
{
"fullUrl": "urn:uuid:b769b1ea-3ec2-4b35-86d2-9a0ca128e1e6",
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"id": "variant-fbn1-001",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "55233-1",
"display": "Genetic analysis master panel"
}
]
},
"subject": {
"reference": "Patient/patient-marfan-001"
},
"effectiveDateTime": "2024-12-20",
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "10828004",
"display": "Positive"
}
]
},
"interpretation": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation",
"code": "POS",
"display": "Positive"
}
]
}
],
"note": [
{
"text": "Pathogene FBN1-Mutation, krankheitsursächlich für Marfan-Syndrom"
}
],
"component": [
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "48018-6",
"display": "Gene studied [ID]"
}
]
},
"valueCodeableConcept": {
"coding": [
{
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}
]
}
},
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "48004-6",
"display": "DNA change (c.HGVS)"
}
]
},
"valueCodeableConcept": {
"text": "c.3217G>A"
}
},
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "48005-3",
"display": "Amino acid change (pHGVS)"
}
]
},
"valueCodeableConcept": {
"text": "p.Gly1073Arg"
}
},
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "53037-8",
"display": "Genetic variation clinical significance [Imp]"
}
]
},
"valueCodeableConcept": {
"coding": [
{
"system": "http://loinc.org",
"code": "LA6668-3",
"display": "Pathogenic"
}
]
}
}
]
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:b4d84fa0-2c48-4613-ba4f-05b75d83c3c9",
"resource": {
"resourceType": "Observation",
"id": "observation-echo-aortic",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "imaging"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "78176-5",
"display": "Aorta root Diameter by US 2D"
}
]
},
"subject": {
"reference": "Patient/patient-marfan-001"
},
"effectiveDateTime": "2024-12-15",
"valueQuantity": {
"value": 48,
"unit": "mm",
"system": "http://unitsofmeasure.org",
"code": "mm"
},
"interpretation": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation",
"code": "H",
"display": "High"
}
]
}
],
"method": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "40701008",
"display": "Echocardiography"
}
]
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:796c77be-100b-4935-b738-ef8d6175d668",
"resource": {
"resourceType": "Observation",
"id": "observation-echo-av",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "imaging"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "18112-3",
"display": "Aortic valve Regurgitation degree by US.doppler"
}
]
},
"subject": {
"reference": "Patient/patient-marfan-001"
},
"effectiveDateTime": "2024-12-15",
"valueCodeableConcept": {
"text": "Grad II"
},
"interpretation": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation",
"code": "A",
"display": "Abnormal"
}
]
}
],
"method": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "40701008",
"display": "Echocardiography"
}
]
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:c9a2b002-1177-4c4e-82c0-a8d32983da28",
"resource": {
"resourceType": "Observation",
"id": "observation-echo-mv",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "imaging"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "18113-1",
"display": "Mitral valve Regurgitation degree by US.doppler"
}
]
},
"subject": {
"reference": "Patient/patient-marfan-001"
},
"effectiveDateTime": "2024-12-15",
"valueCodeableConcept": {
"text": "Grad I"
},
"interpretation": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation",
"code": "A",
"display": "Abnormal"
}
]
}
],
"method": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "40701008",
"display": "Echocardiography"
}
]
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:7aa4841a-ee1c-462f-86c7-00a2705d42f4",
"resource": {
"resourceType": "Procedure",
"id": "procedure-cataract-surgery",
"status": "completed",
"category": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "387713003",
"display": "Surgical procedure"
}
]
},
"code": {
"coding": [
{
"system": "http://fhir.de/CodeSystem/bfarm/ops",
"code": "5-144.5a",
"display": "Extrakapsuläre Extraktion der Linse [ECCE]: Linsenkernverflüssigung [Phakoemulsifikation] über kornealen Zugang: Mit Einführung einer kapselfixierten Hinterkammerlinse, monofokale Intraokularlinse"
},
{
"system": "http://snomed.info/sct",
"code": "54885007",
"display": "Extraction of cataract"
}
],
"text": "Phakoemulsifikation mit IOL-Implantation"
},
"subject": {
"reference": "Patient/patient-marfan-001"
},
"performedDateTime": "2024-11-12",
"reasonReference": [
{
"reference": "Condition/condition-cataract"
}
],
"outcome": {
"text": "Erfolgreiche Linsenimplantation ohne Komplikationen"
},
"note": [
{
"text": "Komplikationslose Phakoemulsifikation beider Augen mit Implantation monofokaler Intraokularlinsen"
}
]
},
"request": {
"method": "POST",
"url": "Procedure"
}
},
{
"fullUrl": "urn:uuid:853a938b-bc21-4757-98cc-c33554ea26af",
"resource": {
"resourceType": "Procedure",
"id": "procedure-aortic-planned",
"status": "preparation",
"category": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "387713003",
"display": "Surgical procedure"
}
]
},
"code": {
"coding": [
{
"system": "http://fhir.de/CodeSystem/bfarm/ops",
"code": "5-354.0a",
"display": "Andere Operationen an Herzklappen: Aortenklappe: Rekonstruktion der Aortenwurzel mit Implantation einer Gefäßprothese nach David"
},
{
"system": "http://snomed.info/sct",
"code": "428179006",
"display": "Replacement of aortic root"
}
],
"text": "Aortenwurzelersatz (David-Operation)"
},
"subject": {
"reference": "Patient/patient-marfan-001"
},
"performedPeriod": {
"start": "2025-03-15"
},
"reasonReference": [
{
"reference": "Condition/condition-marfan-clinical"
}
],
"note": [
{
"text": "Geplante klappensparende Aortenwurzelersatz-Operation nach David bei progredienter Aortenwurzeldilatation"
}
]
},
"request": {
"method": "POST",
"url": "Procedure"
}
},
{
"fullUrl": "urn:uuid:8fb04be6-9930-4aec-8a5f-4ef9b904ae51",
"resource": {
"resourceType": "MedicationStatement",
"id": "medication-losartan",
"status": "active",
"medicationCodeableConcept": {
"coding": [
{
"system": "http://fhir.de/CodeSystem/bfarm/atc",
"code": "C09CA01",
"display": "Losartan"
},
{
"system": "http://snomed.info/sct",
"code": "373567002",
"display": "Losartan"
}
],
"text": "Losartan 50mg"
},
"subject": {
"reference": "Patient/patient-marfan-001"
},
"effectiveDateTime": "2024-12-15",
"reasonReference": [
{
"reference": "Condition/condition-marfan-clinical"
}
],
"note": [
{
"text": "Zur Progressionshemmung der Aortenwurzeldilatation bei Marfan-Syndrom"
}
],
"dosage": [
{
"text": "50mg einmal täglich",
"timing": {
"repeat": {
"frequency": 1,
"period": 1,
"periodUnit": "d"
}
},
"route": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "26643006",
"display": "Oral route"
}
]
},
"doseAndRate": [
{
"doseQuantity": {
"value": 50,
"unit": "mg",
"system": "http://unitsofmeasure.org",
"code": "mg"
}
}
]
}
]
},
"request": {
"method": "POST",
"url": "MedicationStatement"
}
},
{
"fullUrl": "urn:uuid:35d41288-207b-4be7-967a-d92e295d1c75",
"resource": {
"resourceType": "ClinicalImpression",
"id": "clinical-impression-seltene-assessment",
"meta": {
"profile": [
"https://www.medizininformatik-initiative.de/fhir/ext/modul-seltene/StructureDefinition/mii-pr-seltene-clinical-impression|2026.0.0"
]
},
"status": "completed",
"subject": {
"reference": "Patient/patient-marfan-001"
},
"encounter": {
"reference": "Encounter/encounter-cardiology"
},
"effectiveDateTime": "2024-12-15",
"date": "2024-12-15",
"problem": [
{
"reference": "Condition/condition-marfan-suspected"
},
{
"reference": "Condition/condition-marfan-clinical"
},
{
"reference": "Condition/condition-marfan-genetic"
}
],
"investigation": [
{
"code": {
"text": "Echokardiographie"
},
"item": [
{
"reference": "Observation/observation-echo-aortic"
},
{
"reference": "Observation/observation-echo-av"
},
{
"reference": "Observation/observation-echo-mv"
}
]
}
],
"summary": "19-jähriger Patient mit Z.n. Katarakt-OP im ZSE vorstellig. Kardiologische Mitbeurteilung zeigt: Aortenwurzeldilatation (48mm), AKI Grad II, MKI Grad I. Skelettale Merkmale (Hochwuchs 2,13m, Beinlängendifferenz) bestätigen Marfan-Syndrom. Klinische und genetische Diagnose gesichert.",
"finding": [
{
"itemReference": {
"reference": "Condition/condition-marfan-clinical"
}
},
{
"itemReference": {
"reference": "Condition/condition-marfan-genetic"
}
},
{
"itemCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "251036003",
"display": "Aortic root dilatation"
}
]
},
"itemReference": {
"reference": "Observation/symptom-aortic-root"
}
},
{
"itemCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "60234000",
"display": "Aortic valve regurgitation"
}
]
},
"itemReference": {
"reference": "Observation/symptom-aortic-regurg"
}
},
{
"itemCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "48724000",
"display": "Mitral valve regurgitation"
}
]
},
"itemReference": {
"reference": "Observation/symptom-mitral-regurg"
}
},
{
"itemCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "248328003",
"display": "Tall stature"
}
]
},
"itemReference": {
"reference": "Observation/observation-height-001"
}
},
{
"itemCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "707738004",
"display": "Leg length discrepancy"
}
]
},
"itemReference": {
"reference": "Observation/observation-leg-asymmetry"
}
}
],
"prognosisCodeableConcept": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "67334001",
"display": "Guarded prognosis"
}
]
}
],
"note": [
{
"text": "Katarakt in jungem Alter war Anlass für ZSE-Konsultation. Marfan-Syndrom klinisch und genetisch (FBN1-Mutation) bestätigt. OP-Indikation für Aortenwurzelersatz durch Kardiologie gestellt. Medikamentöse Therapie mit Losartan eingeleitet."
},
{
"text": "Multidisziplinäre Betreuung im ZSE etabliert. Regelmäßige kardiologische Kontrollen alle 6 Monate. Genetische Beratung für Familienplanung empfohlen."
}
]
},
"request": {
"method": "POST",
"url": "ClinicalImpression"
}
},
{
"fullUrl": "urn:uuid:258f0a21-4c6e-473d-87e9-36a5bf01bb1a",
"resource": {
"resourceType": "Encounter",
"id": "encounter-ophthalmology",
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB",
"display": "ambulatory"
},
"type": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "36228007",
"display": "Ophthalmic examination and evaluation"
}
]
}
],
"subject": {
"reference": "Patient/patient-marfan-001"
},
"period": {
"start": "2024-10-15",
"end": "2024-10-15"
},
"diagnosis": [
{
"condition": {
"reference": "Condition/condition-cataract"
},
"use": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/diagnosis-role",
"code": "AD",
"display": "Admission diagnosis"
}
]
}
}
]
},
"request": {
"method": "POST",
"url": "Encounter"
}
},
{
"fullUrl": "urn:uuid:70504d04-a6f0-4aa8-bd20-9b475b94438c",
"resource": {
"resourceType": "Encounter",
"id": "encounter-cataract-surgery",
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "SS",
"display": "short stay"
},
"type": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "305408004",
"display": "Admission to surgical department"
}
]
}
],
"subject": {
"reference": "Patient/patient-marfan-001"
},
"period": {
"start": "2024-11-12T07:00:00Z",
"end": "2024-11-12T15:00:00Z"
},
"diagnosis": [
{
"condition": {
"reference": "Condition/condition-cataract"
},
"use": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/diagnosis-role",
"code": "CC",
"display": "Chief complaint"
}
]
}
}
]
},
"request": {
"method": "POST",
"url": "Encounter"
}
},
{
"fullUrl": "urn:uuid:c90d7e24-a787-4d1b-b402-36b64362cc13",
"resource": {
"resourceType": "Encounter",
"id": "encounter-cardiology",
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB",
"display": "ambulatory"
},
"type": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "185228002",
"display": "Seen in cardiac clinic (finding)"
}
]
}
],
"subject": {
"reference": "Patient/patient-marfan-001"
},
"period": {
"start": "2024-12-15",
"end": "2024-12-15"
},
"reasonCode": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "29857009",
"display": "Chest pain"
}
],
"text": "Thoraxschmerzen bei V.a. Marfan-Syndrom"
}
],
"diagnosis": [
{
"condition": {
"reference": "Condition/condition-marfan-clinical"
},
"use": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/diagnosis-role",
"code": "AD",
"display": "Admission diagnosis"
}
]
}
}
]
},
"request": {
"method": "POST",
"url": "Encounter"
}
},
{
"fullUrl": "urn:uuid:1ec76c96-9e7d-403a-9ea5-1f2eaea6ef28",
"resource": {
"resourceType": "Encounter",
"id": "encounter-surgery-planned",
"status": "planned",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "IMP",
"display": "inpatient encounter"
},
"type": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "305357000",
"display": "Admission to cardiology department"
}
]
}
],
"subject": {
"reference": "Patient/patient-marfan-001"
},
"period": {
"start": "2025-03-15"
},
"reasonCode": [
{
"text": "Elektive Aortenwurzelersatz-Operation bei Marfan-Syndrom"
}
],
"diagnosis": [
{
"condition": {
"reference": "Condition/condition-marfan-clinical"
},
"use": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/diagnosis-role",
"code": "CC",
"display": "Chief complaint"
}
]
}
}
]
},
"request": {
"method": "POST",
"url": "Encounter"
}
}
]
}