CPT® Code 93526

Deleted

1. Indications

The combined right heart catheterization and retrograde left heart catheterization is indicated for a variety of clinical scenarios, including but not limited to the following:

• Assessment of Heart Function: This procedure is performed to evaluate the overall function of the heart, particularly in patients with suspected heart failure or other cardiac dysfunctions.
• Measurement of Hemodynamics: It is indicated for obtaining precise measurements of pressures within the heart chambers and pulmonary arteries, which is essential for diagnosing conditions such as pulmonary hypertension.
• Evaluation of Valvular Heart Disease: The procedure is used to assess the function of the tricuspid, pulmonary, aortic, and mitral valves, particularly in patients with suspected valvular abnormalities.
• Coronary Artery Disease: It is indicated for the evaluation of coronary artery disease, allowing for the inspection of the coronary arteries and the assessment of any blockages or abnormalities.
• Preoperative Assessment: This procedure may be performed as part of the preoperative evaluation for patients undergoing cardiac surgery to provide detailed information about cardiac anatomy and function.

2. Procedure

The procedure consists of two main components: right heart catheterization and retrograde left heart catheterization, each with specific steps involved.

• Right Heart Catheterization: The procedure begins with the patient positioned appropriately, and the right femoral vein is selected as the access site. A small stab incision is made to facilitate access, and a needle is inserted into the vein. Following this, a sheath is placed to allow for the introduction of a guidewire. The guidewire is carefully threaded through the femoral vein, progressing through the external iliac vein and inferior vena cava until it reaches the right atrium. Once the guidewire is in place, a catheter is inserted over the guidewire and advanced into the right atrium, right ventricle, and pulmonary arteries. At this point, the guidewire is withdrawn, and the catheter is used to inspect the right heart chambers, measure pressures, and assess oxygen levels. The tricuspid and pulmonary valves are evaluated, and pressure gradients are obtained. If necessary, a separately reportable angiogram of the right heart and/or pulmonary arteries may be performed to visualize any abnormalities.
• Retrograde Left Heart Catheterization: Following the right heart catheterization, the focus shifts to the left heart. The skin over the brachial, axillary, or femoral artery is prepped and cleaned. A needle is then used to puncture the selected artery, and a sheath is placed to facilitate access. A guidewire is inserted and threaded retrograde through the artery into the aorta, and subsequently into the left ventricle and left atrium. A catheter is then advanced over the guidewire and positioned within the left heart. The guidewire is removed, allowing the catheter to be used for inspection of the aortic valve, left ventricle, mitral valve, and left atrium. Pressures in the left ventricle and atrium are measured, and pressure gradients across the aortic and mitral valves are obtained. Additionally, the catheter may be positioned in the right and left coronary arteries for further inspection. If indicated, separately reportable angiograms of the aorta, left heart chambers, coronary arteries, arterial conduits, and/or aortocoronary venous bypass grafts may be performed to provide detailed imaging of the cardiac structures.

3. Post-Procedure

Upon completion of the combined catheterization procedure, the catheters are carefully withdrawn from the access sites. Compression dressings are applied to the puncture sites to minimize bleeding and promote healing. Patients are typically monitored for any complications, such as bleeding or hematoma formation, at the access sites. Recovery may vary depending on the individual patient and the complexity of the procedure, but close observation is essential to ensure stability. Patients may be advised on activity restrictions and follow-up care as needed, based on the findings from the catheterization and any additional interventions that may be required.