CPT® Code 93524

Deleted

1. Indications

The combined transseptal and retrograde left heart catheterization is indicated for the evaluation of specific cardiac conditions, particularly those related to the mitral valve. The following indications are explicitly associated with this procedure:

• Mitral Valve Disease - This procedure is often performed to assess various forms of mitral valve disease, which may include mitral stenosis, mitral regurgitation, or other structural abnormalities affecting the mitral valve.

2. Procedure

The procedure involves several critical steps to ensure successful access to the left heart chambers. The following procedural steps are performed:

• Step 1: Catheter Introduction - A catheter is first introduced into the right atrium of the heart. This initial access is crucial for the subsequent steps of the procedure.
• Step 2: Puncturing the Intra-Atrial Septum - The intra-atrial septum, which separates the right and left atria, is punctured to allow the catheter to be advanced into the left atrium. This step is essential for gaining access to the left side of the heart.
• Step 3: Retrograde Catheterization - A retrograde left heart catheterization is performed by accessing the brachial, axillary, or femoral artery. The skin over the selected artery is prepped, and a needle is used to puncture the artery, followed by the placement of a sheath.
• Step 4: Guidewire Insertion - A guidewire is inserted and threaded retrograde through the artery, into the aorta, and subsequently into the left ventricle and left atrium. This guidewire serves as a pathway for the catheter.
• Step 5: Catheter Positioning - A catheter is then threaded over the guidewire and positioned in the left ventricle. Once the catheter is in place, the guidewire is removed, allowing for the simultaneous positioning of catheters in both the left atrium and left ventricle.
• Step 6: Pressure Recordings - With the catheters positioned, pressure recordings are obtained from both the left atrium and left ventricle, providing valuable hemodynamic data.
• Step 7: Angiograms - As part of the procedure, separate reportable angiograms of the aorta, left heart chambers, coronary arteries, arterial conduits, and/or aortocoronary venous bypass grafts may be obtained to visualize the anatomy and assess for any abnormalities.
• Step 8: Catheter Withdrawal - Upon completion of the necessary assessments and recordings, the catheters are carefully withdrawn from the heart and the access site.
• Step 9: Application of Compression Dressings - Finally, compression dressings are applied to the access site to ensure proper hemostasis and minimize the risk of bleeding.

3. Post-Procedure

After the combined transseptal and retrograde left heart catheterization, patients typically require monitoring for any potential complications, such as bleeding or infection at the access site. The application of compression dressings is crucial for ensuring hemostasis. Patients may also be observed for any signs of cardiovascular instability or adverse reactions to the procedure. Follow-up care may include instructions regarding activity restrictions and signs of complications that should prompt immediate medical attention.