CPT® Code 93514

Deleted

1. Indications

The left heart catheterization by left ventricular puncture is indicated for various clinical scenarios where detailed assessment of the heart's function and structure is necessary. The following conditions may warrant this procedure:

• Assessment of Heart Function This procedure is performed to evaluate the overall function of the left ventricle, particularly in patients with suspected heart failure or other cardiac dysfunctions.
• Measurement of Cardiac Pressures It is indicated for measuring pressures within the left ventricle and aorta, which can help in diagnosing conditions such as aortic stenosis or mitral valve disease.
• Coronary Artery Disease Evaluation The procedure is utilized to assess the presence and severity of coronary artery disease, particularly when non-invasive tests are inconclusive.
• Preoperative Assessment It may be indicated as part of the preoperative evaluation for patients undergoing cardiac surgery to provide critical information about cardiac function and anatomy.

2. Procedure

The left heart catheterization by left ventricular puncture involves several critical procedural steps that ensure accurate access and assessment of the heart's chambers. The following steps outline the procedure:

• Step 1: Site Preparation The procedure begins with the identification of the cardiac apex as the entry site. The skin over the chosen site is cleansed thoroughly to minimize the risk of infection. Local anesthesia is then administered to the area to ensure patient comfort during the procedure.
• Step 2: Puncture and Access After anesthesia, a scalpel is used to puncture the entry site, creating an opening through which a needle can be inserted. The needle is carefully placed through the chest wall, allowing for the introduction of a catheter with a needle trocar.
• Step 3: Catheter Insertion The catheter with the needle trocar is advanced through the skin and subcutaneous tissues until it reaches the apex of the heart. Once in position, the heart is punctured, and entry into the left chamber is confirmed by monitoring pressure readings, which indicate successful access.
• Step 4: Pressure Measurement After confirming the catheter's position, the guiding needle is removed, leaving the catheter in place. Pressures within the left ventricle are recorded, providing essential data for evaluating cardiac function.
• Step 5: Further Advancement The catheter is then advanced into the aorta and/or right atrium, where additional pressure readings are taken. This step is crucial for assessing the hemodynamics of the heart.
• Step 6: Angiography If necessary, the catheter may be maneuvered into the right and left coronary arteries for inspection. Angiograms of the left heart chambers, aorta, and coronary arteries can be obtained to visualize any abnormalities or blockages.
• Step 7: Completion Upon completion of the procedure, the catheter is carefully withdrawn from the access site. Pressure is applied to the site to control any bleeding and promote healing.

3. Post-Procedure

After the left heart catheterization by left ventricular puncture, patients are typically monitored for any complications or adverse effects. It is essential to observe the access site for signs of bleeding or infection. Patients may be advised to rest and limit physical activity for a specified period to facilitate recovery. Follow-up assessments may be scheduled to review the results of the procedure and to discuss any further management or treatment options based on the findings obtained during the catheterization.