CPT® Code 93529

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1. Indications

The combined right heart catheterization and left heart catheterization through an existing septal opening is indicated for various clinical scenarios, including:

• Assessment of Cardiac Function This procedure is performed to evaluate the overall function of the heart, including the assessment of pressures and oxygen levels in the heart chambers.
• Diagnosis of Heart Conditions It is utilized to diagnose conditions such as congenital heart defects, valvular heart disease, and other structural abnormalities of the heart.
• Evaluation of Heart Valve Function The procedure allows for the inspection of the tricuspid, pulmonary, mitral, and aortic valves, as well as the measurement of pressure gradients across these valves.
• Coronary Artery Assessment It may be indicated for the evaluation of the right and left coronary arteries, particularly in patients with suspected coronary artery disease.

2. Procedure

The procedure involves several key steps, which are detailed as follows:

• Step 1: Preparation and Access The skin over the catheter access site is cleansed, and a small stab incision is made to access the right femoral vein. A needle is inserted into the vein, followed by the placement of a sheath to facilitate catheter insertion.
• Step 2: Right Heart Catheterization A guidewire is threaded through the femoral vein, progressing through the external iliac vein, inferior vena cava, and into the right atrium. A catheter is then inserted over the guidewire and advanced into the right atrium, right ventricle, and pulmonary arteries. Once positioned, the guidewire is withdrawn, and various measurements, including pressures and oxygen levels, are taken while inspecting the right heart chambers and valves.
• Step 3: Left Heart Catheterization The catheter is advanced through the existing septal opening into the left heart. The left atrium, mitral valve, left ventricle, and aortic valve are inspected, and left ventricular and atrial pressures are obtained, along with pressure gradients across the aortic and mitral valves.
• Step 4: Coronary Artery Inspection The right and left coronary arteries may be inspected during the procedure, and separately reportable angiograms of the aorta, left heart chambers, coronary arteries, arterial conduits, and/or aortocoronary venous bypass grafts may be obtained as needed.
• Step 5: Retrograde Left Heart Catheterization (if applicable) If a retrograde left heart catheterization is performed, a second catheter is introduced through the brachial, axillary, or femoral artery. This catheter is threaded over a guidewire that has been placed retrograde through the artery, into the aorta, and into the left side of the heart for further inspection and pressure measurements.

3. Post-Procedure

After the combined right and left heart catheterization, patients are typically monitored for any complications or adverse effects. Recovery may involve observation in a healthcare setting to ensure that vital signs remain stable and that there are no signs of bleeding or infection at the catheter access site. Patients may be advised to limit physical activity for a specified period and to follow up with their healthcare provider for any necessary additional evaluations or treatments based on the findings from the procedure.