CPT® Code 0793T

1. Indications

The procedure of percutaneous transcatheter thermal ablation of nerves innervating the pulmonary arteries is indicated for the treatment of pulmonary artery hypertension. This condition can lead to various symptoms and complications, necessitating intervention to manage elevated pulmonary arterial pressure effectively.

• Pulmonary Artery Hypertension This procedure is primarily performed to alleviate the symptoms and complications associated with pulmonary artery hypertension, which is characterized by increased blood pressure in the pulmonary arteries.

2. Procedure

The procedure involves several critical steps to ensure successful ablation of the targeted nerves. Initially, right heart catheterization is performed to access the right side of the heart and measure hemodynamic parameters. This step is essential for evaluating the severity of pulmonary artery hypertension and involves threading a guide catheter through a sheath over a guidewire into the pulmonary artery. Once the catheter is in place, pulmonary artery angiography is conducted to visualize the anatomy of the pulmonary arteries and identify the right and left pulmonary arteries for ablation.

• Step 1: Right heart catheterization is initiated to obtain direct access to the right heart, allowing for the measurement of hemodynamic parameters and blood oxygen saturation levels.
• Step 2: A guide catheter is advanced through the sheath over a guidewire into the pulmonary artery, facilitating further diagnostic and therapeutic interventions.
• Step 3: Pulmonary artery angiography is performed to visualize the pulmonary arteries, enabling the identification of the right and left pulmonary arteries that will be targeted for ablation.
• Step 4: A specialized ablation catheter is then advanced to the opening of the left pulmonary artery over the guidewire, with its position verified to ensure accurate targeting.
• Step 5: The ablation site is confirmed to be within 2 mm of the opening of the left pulmonary artery, and thermal energy is applied at a target temperature between 45-60 degrees centigrade to denervate the artery.
• Step 6: The thermal ablation is repeated at the next site, which is less than 2 mm from the bifurcation of the main pulmonary artery, and again at the opening of the right pulmonary artery.
• Step 7: After completing the ablation, hemodynamic and blood oxygen measurements are taken again to assess the effectiveness of the procedure.
• Step 8: Successful ablation is indicated by achieving an average pulmonary arterial pressure of less than or equal to 10 mm Hg.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications and assessing the effectiveness of the ablation. Continuous hemodynamic monitoring is essential to ensure that the pulmonary arterial pressure remains within the desired range. Patients may require follow-up imaging and assessments to evaluate the long-term outcomes of the procedure. Additionally, the administration of antiplatelet and anticoagulant medications may continue post-procedure to prevent thrombus formation and ensure optimal recovery.