CPT® Code 93531

Deleted

1. Indications

The combined right heart catheterization and retrograde left heart catheterization is indicated for patients with congenital cardiac anomalies. This procedure is performed to evaluate the structural and functional aspects of the heart, particularly when there are concerns regarding the heart's anatomy or hemodynamics. The following conditions may warrant this procedure:

• Congenital Heart Defects Evaluation of various congenital heart defects that may affect blood flow and heart function.
• Assessment of Cardiac Function Determining the functional capacity of the right and left heart chambers in patients with known congenital anomalies.
• Measurement of Hemodynamic Parameters Obtaining precise measurements of pressures and oxygen levels within the heart chambers to guide treatment decisions.

2. Procedure

The procedure consists of two main components: right heart catheterization and retrograde left heart catheterization, each with specific steps that ensure comprehensive evaluation of the heart.

• Right Heart Catheterization The procedure begins with the preparation of the skin over the right femoral vein, which is the typical access site. A small stab incision is made, and a needle is inserted into the vein. Following this, a sheath is placed to facilitate the introduction of a guidewire. The guidewire is carefully threaded through the femoral vein, progressing through the external iliac vein, inferior vena cava, and into the right atrium. Once the guidewire is in place, a catheter is inserted and advanced over the guidewire 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 At this point, the guidewire is withdrawn, and the catheter is used to inspect the right heart chambers. Pressures and oxygen levels are measured, and the tricuspid and pulmonary valves are evaluated, including obtaining pressure gradients. 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 evaluation, the focus shifts to the left heart. The skin over the brachial, axillary, or femoral artery is prepped, and a needle is used to puncture the artery, followed by the placement of a sheath. A guidewire is then inserted and threaded retrograde through the artery into the aorta, and subsequently into the left ventricle and left atrium. A catheter is advanced over the guidewire and positioned within the left heart. The guidewire is removed, allowing for inspection of the aortic valve, left ventricle, mitral valve, and left atrium. During this phase, congenital anomalies of these structures are evaluated, and left ventricular and atrial pressures are obtained, along with pressure gradients across the aortic and mitral valves. Additionally, the catheter may be positioned in the right and left coronary arteries to assess any anomalies present in these vessels.

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 or adverse effects following the procedure. Recovery may vary depending on the individual patient's condition and the complexity of the congenital anomalies addressed during the catheterization. It is essential to provide appropriate post-procedure care and follow-up to ensure optimal recovery and management of any identified cardiac issues.