CPT® Code 93511

Deleted

1. Indications

The left heart catheterization procedure is indicated for various clinical scenarios, including but not limited to the following:

• Assessment of Cardiac Function This procedure is performed to evaluate the function of the left ventricle and left atrium, particularly in patients with suspected heart disease.
• Evaluation of Valvular Heart Disease It is indicated for assessing the aortic and mitral valves, including measuring pressure gradients across these valves to determine the severity of any stenosis or regurgitation.
• Coronary Artery Disease Diagnosis The procedure is utilized to investigate the presence of coronary artery disease, allowing for the visualization of coronary arteries and potential blockages.
• Preoperative Assessment It may be indicated as part of the preoperative evaluation for patients undergoing cardiac surgery to provide detailed information about cardiac anatomy and function.

2. Procedure

The left heart catheterization procedure involves several critical steps, which are detailed as follows:

• Step 1: Preparation The procedure begins with the preparation of the skin over the selected artery, which may be the brachial, axillary, or femoral artery. This includes cleaning the area to reduce the risk of infection.
• Step 2: Arterial Access A needle is used to puncture the artery, and a sheath is placed to facilitate the introduction of other instruments. This step is crucial for ensuring a secure access point for the catheterization.
• Step 3: Guidewire Insertion A guidewire is inserted through the sheath and threaded retrograde through the artery, into the aorta, and subsequently into the left ventricle and left atrium. This allows for the safe navigation of the catheter into the heart.
• Step 4: Catheter Positioning A catheter is then threaded over the guidewire and positioned within the left heart chambers. Once in place, the guidewire is removed, and the catheter is used to measure pressures within the heart.
• Step 5: Pressure Measurement Pressures in the left ventricle and left atrium are obtained, along with pressure gradients across the aortic and mitral valves, providing essential data for diagnosis.
• Step 6: Coronary Angiography If necessary, the catheter may be positioned in the right and left coronary arteries to inspect these vessels for any abnormalities. Angiograms may be obtained to visualize the coronary arteries and assess for blockages.
• Step 7: Completion of Procedure After all necessary measurements and inspections are completed, the catheter is withdrawn. Compression is applied over the arterial puncture site to prevent bleeding, and a compression dressing is applied to secure the site.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications, particularly at the puncture site. Patients are typically advised to remain still and may need to lie flat for a period to ensure proper healing and minimize the risk of bleeding. Follow-up assessments may include checking the puncture site for signs of hematoma or infection. Patients may also be instructed on activity restrictions and signs to watch for that would necessitate immediate medical attention.