CPT® Code 93501

Deleted

1. Indications

The right heart catheterization is indicated for various clinical scenarios where assessment of the right heart function and hemodynamics is necessary. The following conditions may warrant this procedure:

• Heart Failure - To evaluate the cause of heart failure and assess the pressures in the right heart chambers.
• Pulmonary Hypertension - To measure pulmonary artery pressures and determine the severity of the condition.
• Congenital Heart Disease - To assess the hemodynamic status in patients with congenital heart defects.
• Cardiac Transplant Evaluation - To evaluate the right heart function in potential transplant candidates.
• Assessment of Valvular Heart Disease - To inspect the tricuspid and pulmonary valves for any abnormalities.

2. Procedure

The procedure of right heart catheterization involves several critical steps to ensure accurate assessment and measurement of cardiac function. The following steps outline the process:

• Preparation of the Access Site - The skin over the right femoral vein is cleansed thoroughly to reduce the risk of infection. A local anesthetic is injected to numb the area, ensuring patient comfort during the procedure.
• Insertion of the Needle - A small stab incision is made in the skin, and a needle is carefully inserted into the femoral vein. This step is crucial for gaining access to the venous system.
• Placement of the Sheath - Following the needle insertion, a sheath is introduced into the blood vessel to facilitate the subsequent passage of the catheter.
• Threading the Guidewire - A guidewire is threaded through the femoral vein, advancing through the external iliac vein and inferior vena cava, ultimately reaching the right atrium. This guidewire serves as a pathway for the catheter.
• Insertion of the Catheter - The catheter is then inserted over the guidewire into the inferior vena cava and advanced into the right atrium, right ventricle, and into the pulmonary arteries. This step allows for direct access to the right heart chambers.
• Inspection and Measurement - As the catheter is navigated through the right side of the heart, the chambers are inspected visually, and pressure and oxygen level measurements are obtained to evaluate cardiac function.
• Angiogram (if necessary) - A separately reportable angiogram of the right heart and/or pulmonary arteries may be performed to provide additional diagnostic information regarding the vascular structures.
• Completion of the Procedure - Once the necessary measurements and inspections are completed, the catheter is withdrawn. Compression is applied to the venous access site to prevent bleeding, and a dressing is applied to protect the site.

3. Post-Procedure

After the right heart catheterization, patients are typically monitored for any complications, such as bleeding or infection at the access site. The application of compression helps to minimize the risk of hematoma formation. Patients may be advised to rest and avoid strenuous activities for a specified period following the procedure. Follow-up assessments may be necessary to evaluate the patient's recovery and to discuss the results of the procedure, including any further diagnostic or therapeutic interventions that may be required based on the findings.